- Atrial fibrillation (AFib) is the most common type of heart arrhythmia.
- Catheter ablation is one of the more common treatments for the condition.
- Researchers say ablation may pose more health risks for women than men.
- Experts say there are a number of reasons for the increased risks.
Now, a recent study published in the journal Heart, has found that this procedure could be more dangerous for women than men.
For their study, researchers examined complications of catheter ablation for gender-based differences. The scientists looked at 59,000 people in the American College of Cardiology’s National Cardiovascular Data Registry for the study. All the patients were seen at one of 150 U.S. sites between January 2016 and September 2020.
Catheter ablation was first used in 1981 to treat heart arrhythmias. It was first used for AFib in France in 1998. Since then, it has undergone many modifications to make the procedure safer overall and specifically for women.
However, experts say there is still much more information for doctors to understand to continue to make the procedure safer and more effective.
“While atrial fibrillation ablation is an effective procedure that is more and more common, there are gaps in our knowledge regarding its effectiveness and incidence of adverse events in specific patient groups,” Dr. Cyrus Szeto-Wong, a cardiac electrophysiologist with Santa Clara Valley Medical Center in California, told Healthline. “There appear to be possible gender differences with specific adverse events which may be attributable to differences in size and anatomy. However, this could also be related to differences in how atrial fibrillation diagnosis and management is approached in women vs. men.”
The researchers pointed out that as cardiologists have gained a greater understanding of anatomical differences in women, they have instituted some safety protocols.
- They can now use ultrasound rather than feeling for a pulse to place catheters more accurately.
- Catheters are designed to allow cardiologists to judge how much force they are using during the ablation.
- Doctors are now more aware of sex-based differences in blood thinner doses for women at the time of the procedure.
The researchers noted that men tended to experience persistent AFib. At the same time, women were more likely to go in and out of AFib.
The researchers also observed that women experienced more symptoms, such as palpitations, chest pain, fatigue, and dizziness. At the time the ablation procedure was done, they were also often older, had more co-occurring health conditions (comorbidities), and experienced a lower quality of life before the procedure.
Other gender-based differences surrounding the procedure and potential complications included the increased likelihood that women would experience:
- Pericardial effusion (heart perforated and blood builds up around it)
- Slow heart rates that required a permanent pacemaker
- Injury to the phrenic nerve, which can paralyze the diaphragm, causing breathing difficulties
- Vascular damage and bleeding in the groin area at the catheter insertion point that require surgery
- Fluid buildup in the lungs, resulting in shortness of breath or heart failure
- Extended hospital stays
The researchers said they hope that their findings make the procedure safer for women.
“I am not sure if ablation is inherently more dangerous for women,” said Dr. Larry Chinitz, a professor of medicine and cardiac electrophysiology as well as the director of Cardiac Electrophysiology and Heart Rhythm Center at NYU Langone Health.
“Comorbidity is higher in women, which could make it more dangerous,” he told Healthline. “Women also go in for treatment later than men, in general. This could be because they didn’t have symptoms, didn’t pay attention to them, or because medical professionals did not take them seriously. Women can also have more trouble with blood thinners. So, it is not necessarily the procedure, but the situations surrounding it can cause more problems for women.”
Experts say the study could be helpful in how doctors approach ablation and situations to consider before the procedure.
“This study sheds important light on adverse events following an atrial fibrillation ablation concerning gender disparities,” Dr. Salvatore J Savona, an electrophysiologist at The Ohio State Wexner Medical Center, told Healthline. “For women, there was a significant increase in prolonged hospitalization, adverse effects, and reduced quality of life following ablation for AFib. Thankfully, there was no increased risk of death between women and men.”
“In the study, women who underwent ablation had higher rates of atrial fibrillation episodes lasting less than seven days. Additionally, women were more likely to undergo cryoballoon ablation, or cold therapy ablation,” added Savona. “One of the adverse events noted during the study more commonly found in women was phrenic nerve damage. Women also had a smaller left atrial size at baseline in this study, which may have predisposed to higher rates of pericardial effusion. This study will impact how ablations are approached and discussions on future risks and benefits of the procedure.”
The disease is expected to become more common, affecting an estimated 12 million people in the United States by 2030.
A person can have episodes of AFib, or it could be persistent. When the heart is in atrial fibrillation, the blood does not properly flow from the upper chambers of the heart to the lower, potentially causing the pooling of blood, which can lead to blood clots.
Symptoms of AFib include:
- Irregular heartbeat
- Shortness of breath
- Chest pain
Women are more likely to experience AFib, but that could be because the risk of AFib increases with age, and women tend to live longer than men.
In addition to age, other risk factors include:
- High blood pressure
- European ancestry
- Heart failure
- Ischemic heart disease
- Chronic kidney disease
- Moderate to heavy alcohol use
- Enlargement of the left side of the heart
“Atrial fibrillation ablation does not usually eliminate atrial fibrillation,” said Szeto-Wong “Studies have shown that 60 to 80 percent of patients remain free of atrial fibrillation at 1 to 2 years post ablation, and as time passes from the ablation procedure, the odds of recurrence increases. In general, the more AFib you have and the longer it has been present, the lower the success rate of ablation.”
“Catheter ablation is a minimally invasive procedure where catheters are inserted into the heart through the femoral veins in the groin to treat heart arrhythmias, including atrial fibrillation,” explained Dr. Shephal Doshi, a cardiac electrophysiologist and director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in California.
“Its effectiveness varies depending on the patient and the severity and duration of the AFib,” he told Healthline.
There are two types, according to the University of Michigan Health:
- Radiofrequency energy – sometimes called “hot ablation.”
- Cryoballoon ablation – sometimes called “cold ablation.”
“Ablation can be done with catheters that heat tissue to create a scar or with a different kind of catheter involving inflating a balloon that freezes the heart tissue to create a scar,” explained Szeto-Wong. “Both methods appear to be similarly effective for someone undergoing their first AFib ablation. Cold ablation, also known as cryoablation, can be a somewhat faster procedure when done by an experienced physician.”