Women with Atrial Fibrillation Less Likely To Get Catheter Ablation Than Men — And Have More Complications
March 21, 2010 7:08 AM CT
By Peggy Noonan and Mellanie True Hills
A new study shows women who have atrial fibrillation (AF) get catheter ablation treatment less often than men. And when women with afib do have catheter ablation, they have more complications than men.
“Over the past decade, catheter ablation for the management of atrial fibrillation has evolved from a provisional therapy to one that many electrophysiologists routinely use,” the study authors report in the February 2010 edition of the HeartRhythm Journal. Until now, research on catheter ablation for atrial fibrillation has largely been done on men.
This new study was done because there was so little information available about afib catheter ablation in women. Previous research had shown that men and women tended to get different levels of cardiovascular diagnostic testing and such treatments as cardioverter-defibrillators and coronary artery bypass grafts (CABG, called bypass surgery).
In addition, previous studies had found that once women are diagnosed with atrial fibrillation, they are frequently treated less aggressively than males. This is the largest study to date to look at the safety and efficacy of using catheter ablation to treat women living with atrial fibrillation.
Study Findings For Women
Multicenter data was collected between January 2005 and May 2008 on 3,265 men and women with atrial fibrillation who were treated with a type of catheter ablation called pulmonary vein antrum isolation (PVAI, also called pulmonary vein ablation or PVA). Male AF patients served as controls for this study.
The results were staggering, showing that women in the study:
- Had fewer catheter ablations, with men having five times as many
- Were more likely to fail catheter ablations, at 31.5% vs. 22.5% for men
- Were older than men when they had a catheter ablation
- Had failed more antiarrhythmic drugs than men
- Had a higher incidence than men of prior stroke and hypertension (high blood pressure), but a lower incidence of diabetes and coronary artery disease
- Were referred for catheter ablation later in their illness than men
- Had a higher prevalence than men of being in persistent or long-standing persistent atrial fibrillation rather than paroxysmal atrial fibrillation
- Had more non-PV (pulmonary vein) firing sites after catheter ablation than men
- Were twice as likely to fail catheter ablation if they had non-PV firing sites or were non-paroxysmal, which likely came from being in afib longer and resulted from electrical and structural remodeling
- Had more bleeding complications, including more than twice as many hematomas, at 2.1% vs. 0.9% for men — higher body mass index (BMI) was a predictor of these complications and while there was no difference in BMI between women and men, anatomical variations were believed to be the cause
Why such a difference in atrial fibrillation treatment between men and women?
The answer is not clear, though one possible explanation may be that women are older when they agree to have invasive treatment and thus have tried and failed more antiarrhythmic medications before getting a catheter ablation.
Although being male is an independent risk factor for atrial fibrillation, the researchers say age is also a risk factor for afib, and since women usually live longer than men, it works out that the actual numbers are “similar.” And when women have afib, they have more symptoms than men, a poorer quality of life, higher stroke risk and higher death rates from cardiovascular disease.
To learn more, see:
- Outcomes and complications of catheter ablation for atrial fibrillation in females, HeartRhythm Journal, February 2010 — Abstract is free; a subscription is required for the full article
- AF ablation referral, success seem less common in women than men. Why?, Heartwire, TheHeart.org
- Catheter ablation treatment for atrial fibrillation
What Does This Mean For You?
If you’re a woman with atrial fibrillation, what does this mean for you? If your afib is not well controlled with medications, talk to your doctor about whether having a procedure — catheter ablation or surgery, sooner rather than later — is right for you.
But that still leaves the problem of why women are referred later overall for heart procedures. Several years ago we realized that heart disease was being missed in women, largely because it was unexpected. As a result, doctors often treated symptoms rather than the underlying heart disease.
Today, that should no longer be the case with most doctors, hopefully, knowing that heart disease is an equal-opportunity disease, impacting women as much as men. I think today it’s more often an issue of differing communication styles between doctors and women patients.
Doctors are trained to listen for facts, but as women we may be “genetically programmed” to communicate with more emotion and feelings that give context and richness to our messages. That can create miscommunication as doctors may not hear or understand all of what we’re saying. I often hear a common refrain of “my doctor didn’t listen to me.” It may actually be a case of the doctor hearing the words, but not the whole message.
While in an ideal world, doctors would learn how to listen for our whole message, that won’t happen overnight. So for our own health’s sake, we must learn how to communicate directly, succinctly, and completely with our doctors. We must give them the facts they need to make better decisions for our health.
The following articles provide some additional ideas on communicating with doctors, and are useful for both women and men.
- Partnering with Your Doctor
- Atrial Fibrillation and Clueless Doctors
- Speak Up to Get the Atrial Fibrillation Treatment You Deserve
To discuss this study, visit the topic in the StopAfib Discussion Forum here.
Peggy Noonan specializes in writing about health for consumers and medical professionals. She writes for leading national magazines and consumer publications as well as StopAfib.org.
Mellanie True Hills is founder and CEO of StopAfib.org and an atrial fibrillation survivor.