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      Sex and racial disparities in catheter ablation

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          Abstract

          Sex and racial disparities in the presentation, diagnosis, and management of cardiac arrhythmias are recognized. Sex-specific differences in electrophysiological parameters are well known and are predominantly related to differences in ion channel expression and the influence of sex hormones. However, the relationship between hormonal or racial influence and arrhythmia mechanisms, presentation, and management needs to be better defined. Women and racial and ethnic groups are less likely to undergo catheter ablation procedures for treatment of cardiac arrhythmias. Underrepresentation of women and racial/ethnic groups in clinical trials has resulted in significant knowledge gaps. Whether sex and racial disparities in arrhythmia management reflect barriers in access to care, physician bias, patient values, and preferences or other factors requires further study.

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          Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts : Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe)

          Christina Magnussen, Teemu J. Niiranen, Francisco M. Ojeda … (2017)
          Background: Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood. Methods: In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1–97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years. Results: Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12–1.23 in women versus 1.31; 95% CI 1.25–1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81–0.90 versus 0.92; 95% CI, 0.88–0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index. Conclusions: Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.
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            Prophylactic catheter ablation for the prevention of defibrillator therapy.

            Vivek Reddy, Matthew R. Reynolds, Petr Neuzil … (2007)
            For patients who have a ventricular tachyarrhythmic event, implantable cardioverter-defibrillators (ICDs) are a mainstay of therapy to prevent sudden death. However, ICD shocks are painful, can result in clinical depression, and do not offer complete protection against death from arrhythmia. We designed this randomized trial to examine whether prophylactic radiofrequency catheter ablation of arrhythmogenic ventricular tissue would reduce the incidence of ICD therapy. Eligible patients with a history of a myocardial infarction underwent defibrillator implantation for spontaneous ventricular tachycardia or fibrillation. The patients did not receive antiarrhythmic drugs. Patients were randomly assigned to defibrillator implantation alone or defibrillator implantation with adjunctive catheter ablation (64 patients in each group). Ablation was performed with the use of a substrate-based approach in which the myocardial scar is mapped and ablated while the heart remains predominantly in sinus rhythm. The primary end point was survival free from any appropriate ICD therapy. The mortality rate 30 days after ablation was zero, and there were no significant changes in ventricular function or functional class during the mean (+/-SD) follow-up period of 22.5+/-5.5 months. Twenty-one patients assigned to defibrillator implantation alone (33%) and eight patients assigned to defibrillator implantation plus ablation (12%) received appropriate ICD therapy (antitachycardia pacing or shocks) (hazard ratio in the ablation group, 0.35; 95% confidence interval, 0.15 to 0.78, P=0.007). Among these patients, 20 in the control group (31%) and 6 in the ablation group (9%) received shocks (P=0.003). Mortality was not increased in the group assigned to ablation as compared with the control group (9% vs. 17%, P=0.29). In this randomized trial, prophylactic substrate-based catheter ablation reduced the incidence of ICD therapy in patients with a history of myocardial infarction who received ICDs for the secondary prevention of sudden death. (Current Controlled Trials number, ISRCTN62488166 [controlled-trials.com].). Copyright 2007 Massachusetts Medical Society.
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              Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study.

              Marmar Vaseghi, Roderick Tung, David Frankel … (2015)
              The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown.
              Article 0 comments Cited 149 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Anne M. Gillis
                Journal
                Journal ID (nlm-ta): Heart Rhythm O2
                Journal ID (iso-abbrev): Heart Rhythm O2
                Title: Heart Rhythm O2
                Publisher: Elsevier
                ISSN (Electronic): 2666-5018
                Publication date PMC-release: 16 December 2022
                Publication date Collection: December 2022
                Publication date (Electronic): 16 December 2022
                Volume: 3
                Issue: 6Part B
                Pages: 771-782
                Affiliations
                [∗ ]Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
                [† ]Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
                [‡ ]Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
                Author notes
                [∗ ] Address reprint requests and correspondence: Dr Anne M. Gillis, Libin Cardiovascular Institute, University of Calgary, Foothills Medical Centre, 1403–29 St NW, Calgary T2N 2T9, Alberta, Canada. amgillis@ 123456ucalgary.ca
                Article
                Publisher Item ID: S2666-5018(22)00207-0
                DOI: 10.1016/j.hroo.2022.08.002
                PMC ID: 9795271
                PubMed ID: 36589007
                SO-VID: d6d5133b-dcf9-4a74-ad2d-b90567b4ff00
                Copyright © © 2022 Heart Rhythm Society. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Subject: Topics in Review

                Keywords: atrial fibrillation,catheter ablation,ethnicity,race,sex differences,supraventricular tachycardia,ventricular arrhythmia
                Data availability:
                Keywords: atrial fibrillation, catheter ablation, ethnicity, race, sex differences, supraventricular tachycardia, ventricular arrhythmia

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