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Journal of Atrial Fibrillation logoLink to Journal of Atrial Fibrillation
. 2014 Apr 30;6(6):1024. doi: 10.4022/jafib.1024

Sex Differences In Outcomes Of Ablation Of Atrial Fibrillation

Hiroko Beck 1, Anne B Curtis 1
PMCID: PMC5135236  PMID: 27957059

Abstract

Sex-related differences in the presentation, treatment, and outcomes of cardiovascular disease have been reported in many areas of cardiovascular medicine, including the clinical course and treatment of atrial fibrillation (AF). Women appear to be more symptomatic, have a lower quality of life, and are less tolerant of antiarrhythmic drugs than men. However, the rate of referral of women for catheter ablation of AF is significantly lower than men, and women are referred much later after failing more antiarrhythmic drugs. There is a trend toward a lower success rate and a higher failure rate for catheter-based AF ablation in women. This finding may be related to the later referral of women for the procedure, resulting in high risk features such as more severe hypertension, greater left atrial size, and more persistent AF at the time of the procedure, all of which are associated with future recurrences. The complication rate from AF ablation is significantly higher in women, particularly with respect to bleeding and vascular complications such as hematomas and pseudoaneurysms. Individualized care including earlier referrals, pre-procedural case planning, and close monitoring intra- and post procedure may improve the outcomes for women with catheter ablation of AF.

Keywords: Atrial Fibrillation, Stroke, Bleeding, Risk Assessment

Introduction

Sex-related differences in the presentation, treatment, and outcomes of cardiovascular disease have received increasing attention in recent years. There is widespread underuse of cardiovascular procedures in women, including coronary angiography, revascularization, and implantable cardioverter-defibrillators.[1-4] Such sex-related differences have also been reported in the presentation and management of atrial fibrillation (AF), including catheter ablation.[5-8] Women appear to be more symptomatic from the arrhythmia,[9-10] have higher heart rates at the time of presentation,[9] and present with a lower quality of life.[11] Although these characteristics would seem to encourage a rhythm control approach, the use of antiarrhythmic drugs is not always possible, as both bradyarrhythmias and torsade de pointes have been observed more frequently in women.[12-14] In this setting, catheter ablation of AF is certainly an attractive option to both patients and physicians.

The use of catheter ablation is rapidly growing. In Cappato’s worldwide survey between 1995 and 2002, the median number of procedures per center was 37.5 (range, 1-600), whereas in his updated survey between 2003-2006, it rose to 245 (range, 2-2715).[15-16] The 2012 Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society Expert Consensus Document on Catheter Ablation of AF determined that catheter ablation of AF should have a Class I Level of Evidence A recommendation in patients with paroxysmal AF who have failed treatment with at least one antiarrhythmic medication, and a Class IIa Level of Evidence B recommendation for patients with paroxysmal AF who have not failed antiarrhythmic drug therapy.[17] Although commonly used in younger patients with paroxysmal AF, catheter ablation is increasingly employed as well in patients with persistent or long-standing persistent AF.[18] With increasingly widespread use of the procedure, it is prudent to understand the various factors that affect outcomes in AF ablation. The purpose of this article is to review the presentation and treatment outcomes of AF in women, with particular attention to the success rates and complication rates of AF ablation, in order to highlight differences compared to men and opportunities for improved outcomes.

Search engines including PubMed were used for all publication types in the English language, using the search terms describing the concepts of AF and sex. These terms included atrial fibrillation ablation, sex, gender, women, outcome, success, efficacy, recurrence, complications, prevalence, incidence, epidemiology, presentation, and treatment. Full-length manuscripts were reviewed. The reference sections from the identified publications were also used for further search. Several studies specifically addressed sex differences in outcomes and complication rates, as discussed below. Most of the other available major reports on outcomes of AF ablation did not specifically report on outcomes in men versus women, although sex was often included in multivariable analyses of predictors of success rates. In addition, several of them reported on sex differences in complication rates, which we have included in our review.

Presentation And Treatment Of AF In Women

AF is the most common arrhythmia in clinical practice, with an estimated prevalence in the United States of 2.7 to 6.1 million that is expected to increase to 5.6 to 12.2 million by 2050.[19-21] The prevalence of AF is higher at all ages in men than in women.[22] However, since there are almost twice as many women as men older than 75 years in the general population, the absolute number of women with AF is equal to or greater than men.[22,23]

Multiple studies have found that women are more symptomatic from AF and have a lower quality of life.[9-11] One of the explanations for this finding may be due to their higher presenting heart rates. A prospective study by Hnatkova et al. showed the mean heart rate of women at the onset of AF was 123±35 beats/minute vs. 115±20 beats/minute in men.[25] Similar heart rate differences in AF between sexes were observed in an analysis of the Canadian Registry of AF, which found higher mean heart rates during AF in women (126.2±1.9 vs. 119.1±1.4 beats/minute in men). It has also been reported that women are more likely to experience longer (>24 hours) symptomatic episodes and frequent recurrences of AF.[9] Women have a lower quality of life related to AF, which may be attributed to depression as well as a more heightened sense of symptoms. Ong et al. performed a cross-sectional study of 93 patients with AF to evaluate the role of depression on quality of life. It revealed that women reported higher depression scores relative to men, and depression was related to lower physical and mental quality of life.[26]

Women have more episodes of bradyarrhythmias when treated with antiarrhythmic drugs. In a sub-analysis from the Rate Control Versus Electrical Cardioversion (RACE) Study, severe adverse effects of antiarrhythmic drugs and pacemaker implantations occurred more often in women. Such adverse events included manifestations of sick sinus syndrome on flecainide, sotalol, or amiodarone, and torsades de pointes on sotalol.[12,14] More frequent episodes of torsades de pointes in women have previously been reported on multiple antiarrhythmic drugs, including ibutilide and sotalol.[27-29] Sex differences in susceptibility to torsades de pointes may be related to fluctuating QT intervals on antiarrhythmic drugs due to hormonal changes[30,31] and longer baseline QT intervals in women

As women are more symptomatic from AF and less tolerant of antiarrhythmic drugs, catheter ablation appears to be a suitable option. However, multiple studies indicate that women are referred less often for catheter ablation.[15,16,32-42] The percentage of women among patients referred for ablation in these studies ranged from 15.8 to 33.2%. Later referral of women is suggested by the significantly older age of women compared to men at the time of ablation, although this later referral may reflect at least in part the higher prevalence of AF in men in younger age groups.[32,33,35] Roten et al. also reported a trend of fewer and later referrals of women to electrophysiology consultation in an outpatient-based study.[43]

Overall Success And Complication Rates of AF Ablation

Multiple studies have described overall outcomes and complication rates of AF ablation. A majority of these publications, including randomized clinical trials and meta-analyses, have high percentages of male patients with paroxysmal AF and few co-morbidities. With this caveat in mind, the efficacy of AF ablation in randomized trials has been reported to be in the range of 66 to 89% with up to 12 months of follow-up.[17,18,36-42] Despite the heterogeneity of these studies due to variables such as definition of recurrence, ablation methods, choices of antiarrhythmic drugs, the number of repeat procedures and the above-mentioned patient characteristics, several meta-analyses report consistent overall success rates of 75.6-77.8% in the ablation arms as compared with 18.8-29% in the control groups of clinical studies.44-47 A more recent meta-analysis evaluated long-term outcomes of AF ablation and reported the overall long-term success rate after ≥3 years of follow-up to be 79.8%, with an average of 1.51 procedures per patient.[48] In addition to these randomized clinical trials and meta-analyses, two worldwide surveys have been published, representing the outcomes from over 180 centers. An initial worldwide survey (1995 -2002) reported the success rate, defined as freedom from symptomatic AF in the absence of antiarrhythmic therapy, to be 52%. In the updated worldwide survey (2003-2006), a 70% efficacy rate free of antiarrhythmic drugs and an additional 10% efficacy rate in the presence of previously ineffective antiarrhythmic drugs were reported.[15,16]

Complication rates from some of the meta-analyses, which included evaluations of 10 randomized controlled trials and 18 non-randomized controlled trials, are in the range of 2.9 to 7.9%.[44,46,47] Two worldwide surveys reported major complication rates of 6% (1995-2002 and 4.5% (2003-2006).[15,16] Recently, in-hospital complications associated with catheter ablation of AF in the U.S. were analyzed for 93,801 procedures performed between 2000-2010, utilizing data from the Nationwide Impatient Sample, a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project, including a 20% sample of U.S. community hospitals. This study reported the overall complication rate to be 6.29%, comparable to other findings.[49]

Success Rates Of AF Ablation In Women

There has not been any consistent evidence to support female sex as a predictor for recurrence after AF ablation based on multiple univariate and multivariate analyses.[48,50,51] Balk et al. performed a systemic review of predictors of AF recurrence after catheter ablation and reported that none of 23 studies with Cox hazard predictor analyses found female sex to be a predictor of recurrence. A recent meta-analysis by Ganesan et al. reported conflicting data among various studies, including two that showed male sex as a predictor of recurrence and two other studies that found female sex to be a predictor of recurrence of AF. Heist et al. reported male sex as a multivariate predictor of overall clinical success in their analysis of 143 patients with persistent and longstanding persistent AF patients who failed antiarrhythmic therapy.[51]

In an attempt to evaluate sex-related differences in depth, at least four major studies have examined outcomes in women as primary end points in the past decade (Table 1,2). A study by Forleo et al. evaluated 221 consecutive patients from two centers who underwent catheter ablation for drug-refractory AF.[32] This study provided early objective evidence of sex-related differences in AF ablation. Women had a longer history of AF (median 60 vs. 47 months; P = 0.042), yet they represented only 32.1% of the patients referred for catheter ablation. Left atrial dimensions were significantly larger in women (Table 1). The success rate was evaluated in terms of freedom from arrhythmia recurrence on or off antiarrhythmic drugs after the last ablation following a one month blanking period. Despite these high risk profiles in women, after 22.5+11.8 months of follow-up with holter monitoring at periodic intervals, overall freedom from arrhythmia recurrence was similar (Table 2). Improvement in quality of life measured at six months also did not show significant sex differences, as assessed by the Medical Outcome Study 36-Item Short-Form General Health Survey (SF-36), although there was a trend toward better improvement in quality of life in women. Thus, in this study, there was no statistically significant difference in the success rate or improvement in quality of life after pulmonary vein isolation despite sex disparities in risk factors.

Table 1. Characteristics of Patients Undergoing AF Ablation by Sex.

AF: atrial fibrillation; CAD: coronary artery disease; HTN: hypertension; LVEF: left ventricular ejection fraction. *P < 0.05

Study Left atrial diameter (mm) LVEF (%) Comorbidities (%)
Women Men Women Men Type Women Men
Forleo, 2007 44.0±6.5 40.6±6.3* 57.4±3.4 57.0±7.5 HTN 52.1 30.7*
Valvular disease 15.5 5.3*
Stroke 8.5 8.7
Structural heart diseas 32.4 23.3
Patel, 2009 43±0.5 46±0.3* 56±8 49±5* HTN 55.2 40*
Diabetes type II 15 11*
Stroke 3.8 1.6*
CAD 11.3 7*
Zhang, 2013 45.9±0.5 45.5±5.7 59.6 ± 4.2 58.3± 6.2 HTN 42.5 40.1
Rheumatic heart disease 19.2 1.4*
Stroke 11.0 8.8
Takiga wa, 2013 37.2±5.0 38.0±5.1 68.6 ± 6.2 65.6± 7.0* HTN 46.5 43.1
Valvular disease 7.0 4.4
Stroke 7.7 7.5
Structural heart disease 17.8 16.4

Table 2. Outcomes of AF Ablation in Women .

n: number of patients enrolled. AF: atrial fibrillation; PV: pulmonary vein. *P < 0.05

Study Design (enrollment, N) % Women Age, years % Paroxysmal AF Success Rate, %(includes redo) Complication Rate, % Major Complication Type, %
Women Men women Men women Men women Men Type Women Men
Forleo, 2007 Prospective, two center, cohort (221) 32.1 61.6 ± 8.3 56.9 ± 10.8* 56.3 61.3 83.1 82.7 5.6 4.7 Pericardial tamponade 2.8 1.3
Thromboembolic 0 1.3
Pericardial effusion 1.4 1.3
PV stenosis 1.4 0.7
Patel, 2009 Retro-spective, multi-center (3265) 15.8 59 ± 13 56 ± 19* 46 55* 68.5 77.5* 5 2.4* Hematomas 2.1 0.4
PV stenosis 1.2 0.6
Stroke 0.8 0.29
Pericardial effusion 0.4 001*
Pseudoaneurysms 0.6 0.9*
Zhang, 2013 Prospective, single center (220) 33.2 62.7 ± 10.6 61.1 ± 10.4 All persistent AF All persistent AF 35.6 (54.8) 57.1* (66.0) 8.2 3.4 Pericardial effusion 1.4 1.4
Pericardial tamponade 0 0.7
PV stenosis 0 0
Hematomas 6.8 0.7*
Pseudoaneurysms 8.2 3.4
Takigawa, 2013 Prospective, single center (1124) 24 63.2 ± 9.1 60.0 ± 10.5* All paroxysmal AF All paroxysmal AF 56.4 (76.5) 59.3 (81.3*) 3.7 4.1 Tamponade/effusion 1.8 1.3
PV stenosis 0.3 0.1
Vascular injury 0.59 0.1

Subsequently, a large retrospective multicenter study was performed by Patel et al. on 3265 consecutive patients with highly symptomatic and drug-refractory AF who underwent pulmonary vein antral isolation between January 2005 and May 2008 to evaluate outcomes in women.33 Again, women constituted a much lower percentage of the patients referred for ablation, and they were older at the time of the procedure (Table 2). Women failed more antiarrhythmic drugs and were referred later for catheter ablation compared to men. Significantly more women had hypertension. Success rates were reported after initial ablation at each participating center off antiarrhythmic drugs. After 24±16 months of follow-up, women had significantly lower success rates than men (68.5 vs. 77.5% <0.001). Cox regression analysis demonstrated that in female patients, higher body mass index (BMI), non-paroxysmal AF, and non-pulmonary vein triggers predicted procedural failure. Women with non-paroxysmal AF or non-pulmonary vein triggers were twice as likely to fail catheter ablation. Although retrospective, this larger multicenter study suggested significantly lower success rates and higher failure rates in women who underwent pulmonary vein isolation.

Zhang et al. performed a prospective, single center, observational cohort study, evaluating 220 consecutive patients with long-standing, persistent, symptomatic and drug-refractory AF who underwent pulmonary vein isolation with or without complex fractionated atrial electrogram ablation (CFAEs) and linear ablation between January 2010 and May 2011.[34] This was the first study to focus on sex differences in ablation of persistent AF. This study also revealed a lower referral rate in women for ablation. After an average follow-up of 19±5.0 months, women had a lower success rate than men after a single catheter ablation procedure (35.6% in women vs. 57.1% in men; P = 0.003). However, once repeat ablation was taken into consideration, there was no significant sex difference in success rates (54.8% in women and 66.0% in males; P = 0.417) (Table 2). Given the lower initial success rate, it is not surprising that more women underwent re-ablation procedures compared to men. A Cox regression analysis demonstrated that total duration of AF and sex were independent predictors of recurrence after the first catheter ablation.

Most recently, a large scale prospective analysis of sex-related differences in catheter ablation of AF that enrolled 1124 paroxysmal AF patients was reported from Japan.[35] After a mean follow-up of 31.7±24.4 months following the index ablation, there was no significant difference in success rates between women and men. When redo procedures were included, the success rate was significantly lower in women compared to men after the last ablation, with a mean follow-up period of 39.0±21.8 months (Table 2). No significant predictors of recurrence in women were found either by univariate or multivariate Cox proportional analysis. This study also found no significant difference in the rates of complications between women and men.

The differences in these four studies with respect to outcomes of ablation of AF may be due to differences in patient population, sample size, and physician’s decision making. The most recent study (Takagawa et al.) evaluated paroxysmal AF only, whereas Zhang’s study targeted persistent AF patients. As persistence and duration of AF correlate with a high recurrence rate, such differences would be expected to affect the findings. The studies by Patel and Zhang appear to agree that women have lower success rates after the first ablation for AF, and they also have more high risk features for recurrence.[34,35]

Sex-related recurrence rates have been reported as non-primary end points in at least 17 other studies. Most of these trials did not reveal significant sex-related differences in success rates.[52-67] All of these trials reported low referral rates for ablation in women, in the range of 14-35%, and some reported late referral of women for ablation,[32,33,35,52-65] as observed in other procedures in cardiovascular medicine.[1-4] Under referral and late referral of women for ablation of AF may increase the likelihood that women will have more advanced disease and higher risk features by the time of ablation and may lower the success rate. Anatomical differences in left atrial size have also been suggested as a possible culprit in the sex-related difference in success/failure rate; however, a recent study did not find a significant sex difference in left atrial antrum size despite significant differences in outcome.[34]

Complication Rates Of AF Ablation In Women

Female sex has been reported as a predictor of complications after AF ablation, and higher complication rates from AF ablation in women have been found repeatedly.[15,33,34,48,68-73] The multicenter U.S. retrospective study by Patel et al. reported total complications of 3265 (518 in women vs. 2747 in men), with a 5% complication rate in women vs. 2.4% in men (P < 0.001). This study also found more hematomas and pseudoaneurysms in women (Table 2).[33] In Zhang’s study, the complication rate was higher in women, with a marked increase in hematomas.[34] A prospective analysis of 641 procedures (22.3% women) who underwent catheter ablation of AF from a single center reported more major adverse clinical events, defined as those that required intervention, resulted in long-term disability, or prolonged hospitalization, in women (P = 0.014; odds ratio 3.0, 95% confidence interval 1.3-7.2).68 The same group reported female sex as a predictor of complications in both univariate and multivariate analyses.[72]

Another prospective single-center analysis of procedural complications in the Vanderbilt AF Registry evaluated 445 patients who underwent AF ablation. This study reported a significant increase in complications in obese women. Morbidly obese patients experienced a higher rate of complications (14.3% vs. 6.2% in non-morbidly obese patients; P = 0.046). Using a discrete BMI cutoff, the odds of complications increased 3.1-fold in those with morbid obesity and 2.1-fold in women. With BMI as a continuous variable, the odds ratio for complications increased by 5% per 1 unit increase in BMI, and the risk in women was increased 2.2-fold.[69] A recent in-hospital analysis also revealed overall higher complication rates in women (7.51% vs. 5.49%; P < 0.001).[49] A large multicenter registry data from Italy enrolling 2323 patients also reported a significantly higher complication rate in women (7% vs. 4.4%), and female sex was reported to be an independent predictor of a higher risk of complications by univariate analysis (odds ratio 2.643, 95% confidence interval 1.686-4.143, P < 0.0001).[70] Shah et al. also reported female sex to be a predictor of a higher risk of complications from AF ablation in their retrospective data analysis of 4156 patients.[73]

Why do women, particularly those who are morbidly obese, pose a higher risk for complications? As hematomas and pseudoaneurysms are reported to occur more often in women, vascular access appears to play a significant role in the higher rate of complications. Variations in the anatomy of the femoral vasculature have been well reported.[74,75] Schnyder et al. performed a prospective analysis of 200 consecutive common femoral artery angiograms. Their multivariate analysis revealed female sex as a predictor of small vessel size (P = 0.0005).[75] Although no specific studies have been performed, femoral venous anatomy, size, and proximity to the femoral artery could well be affected by sex, potentially increasing the risk of access-related complications in women, particularly in morbidly obese individuals. As systemic heparinization is routinely used during AF ablation, a differential effect of heparin in men and women may also play a role in sex differences in complication rates. Campbell et al. prospectively studied 199 consecutive patients presenting with proximal deep vein thrombosis not related to catheter ablation procedures. They assessed activated partial thromboplastin time (aPTT) values and heparin levels every 4 to 6 hours after a standard heparin bolus and infusion. The results revealed significantly higher heparin levels and higher aPTT values in women (P = 0.0002). After achieving therapeutic aPTT levels, women received lower heparin doses than the men, yet had higher heparin levels.[76] A sex difference in the pharmacokinetics of heparin was also suggested by Winkle et al., who found significantly higher activated clotting times (ACT) in women in an analysis of 1122 AF ablations. Women received less heparin but were over-represented in the higher ACT ranges (P < 0.0001).[77] This variation in the pharmacokinetics of heparin in women may contribute to a higher bleeding risk, predisposing women to a greater risk for hematomas. With these anatomical and pharmacological variations in women, extra modalities, such as vascular ultrasound or closer monitoring of activated clotting time, may be necessary to help reduce the number of complications in women.

Conclusion

Success rates for AF ablation are clearly higher in earlier stages of the disease process, when the arrhythmia is paroxysmal, left atrial size is relatively normal, and left ventricular function is preserved. Thus, it becomes clear that in order to have a comparable success rate of AF ablation in women, symptomatic women need appropriately early referrals for ablation before they develop a high risk profile.

When ablation is chosen as the treatment option for AF, it should be performed with extra attention to complications in women, particularly with respect to vascular access, as women appear to be at increased risk for these complications.

Individualized care involving early referrals, pre-procedural case planning, and close monitoring intra- and post procedure may improve the odds for women to have better outcomes with catheter ablation of AF.

Disclosures

Hiroko Beck: None Anne B. Curtis: Advisory boards: Biosense Webster; Sanofi Aventis; St. Jude Medical; Janssen Pharmaceuticals; Pfizer, Inc.; Daiichi Sankyo; Bristol Myers Squibb Honoraria: St. Jude Medical; Medtronic, Inc.Research grant: Medtronic, Inc.

References

  • 1.Ayanian J Z, Epstein A M. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N. Engl. J. Med. 1991 Jul 25;325 (4):221–5. doi: 10.1056/NEJM199107253250401. [DOI] [PubMed] [Google Scholar]
  • 2.Wong C C, Froelicher E S, Bacchetti P, Barron H V, Gee L, Selby J V, Lundstrom R, Swain B, Truman A. Influence of gender on cardiovascular mortality in acute myocardial infarction patients with high indication for coronary angiography. Circulation. 1997 Nov 4;96 (9 Suppl):II–51-7. [PubMed] [Google Scholar]
  • 3.Hernandez Adrian F, Fonarow Gregg C, Liang Li, Al-Khatib Sana M, Curtis Lesley H, LaBresh Kenneth A, Yancy Clyde W, Albert Nancy M, Peterson Eric D. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA. 2007 Oct 3;298 (13):1525–32. doi: 10.1001/jama.298.13.1525. [DOI] [PubMed] [Google Scholar]
  • 4.Shehab Abdulla, Al-Dabbagh Bayan, AlHabib Khalid F, Alsheikh-Ali Alawi A, Almahmeed Wael, Sulaiman Kadhim, Al-Motarreb Ahmed, Nagelkerke Nicolaas, Al Suwaidi Jassim, Hersi Ahmad, Al Faleh Hussam, Asaad Nidal, Al Saif Shukri, Amin Haitham. Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). PLoS ONE. 2013;8 (2):e55508. doi: 10.1371/journal.pone.0055508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Curtis Anne B, Narasimha Deepika. Arrhythmias in women. Clin Cardiol. 2012 Mar;35 (3):166–71. doi: 10.1002/clc.21975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Sudduth Tiffany L, Schmitt Frederick A, Nelson Peter T, Wilcock Donna M. Neuroinflammatory phenotype in early Alzheimer's disease. Neurobiol. Aging. 2013 Apr;34 (4):1051–9. doi: 10.1016/j.neurobiolaging.2012.09.012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Santangeli Pasquale, di Biase Luigi, Pelargonio Gemma, Natale Andrea. Outcome of invasive electrophysiological procedures and gender: are males and females the same? J. Cardiovasc. Electrophysiol. 2011 May;22 (5):605–12. doi: 10.1111/j.1540-8167.2010.01920.x. [DOI] [PubMed] [Google Scholar]
  • 8.Yarnoz Michael J, Curtis Anne B. More reasons why men and women are not the same (gender differences in electrophysiology and arrhythmias). Am. J. Cardiol. 2008 May 1;101 (9):1291–6. doi: 10.1016/j.amjcard.2007.12.027. [DOI] [PubMed] [Google Scholar]
  • 9.Humphries K H, Kerr C R, Connolly S J, Klein G, Boone J A, Green M, Sheldon R, Talajic M, Dorian P, Newman D. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation. 2001 May 15;103 (19):2365–70. doi: 10.1161/01.cir.103.19.2365. [DOI] [PubMed] [Google Scholar]
  • 10.Volgman Annabelle S, Manankil Marian F, Mookherjee Disha, Trohman Richard G. Women with atrial fibrillation: Greater risk, less attention. Gend Med. 2009 Sep;6 (3):419–32. doi: 10.1016/j.genm.2009.09.008. [DOI] [PubMed] [Google Scholar]
  • 11.Dagres Nikolaos, Nieuwlaat Robby, Vardas Panos E, Andresen Dietrich, Lévy Samuel, Cobbe Stuart, Kremastinos Dimitrios Th, Breithardt Günter, Cokkinos Dennis V, Crijns Harry J G M. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J. Am. Coll. Cardiol. 2007 Feb 6;49 (5):572–7. doi: 10.1016/j.jacc.2006.10.047. [DOI] [PubMed] [Google Scholar]
  • 12.Rienstra Michiel, Van Veldhuisen Dirk J, Hagens Vincent E, Ranchor Adelita V, Veeger Nic J G M, Crijns Harry J G M, Van Gelder Isabelle C. Gender-related differences in rhythm control treatment in persistent atrial fibrillation: data of the Rate Control Versus Electrical Cardioversion (RACE) study. J. Am. Coll. Cardiol. 2005 Oct 4;46 (7):1298–306. doi: 10.1016/j.jacc.2005.05.078. [DOI] [PubMed] [Google Scholar]
  • 13.Michelena H I, Ezekowitz M D. Atrial fibrillation: are there gender differences? J Gend Specif Med. 2001 Mar 20;3 (6):44–9. [PubMed] [Google Scholar]
  • 14.Michelena Hector I, Powell Brian D, Brady Peter A, Friedman Paul A, Ezekowitz Michael D. Gender in atrial fibrillation: Ten years later. Gend Med. 2010 Jun;7 (3):206–17. doi: 10.1016/j.genm.2010.06.001. [DOI] [PubMed] [Google Scholar]
  • 15.Cappato Riccardo, Calkins Hugh, Chen Shih-Ann, Davies Wyn, Iesaka Yoshito, Kalman Jonathan, Kim You-Ho, Klein George, Packer Douglas, Skanes Allan. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005 Mar 8;111 (9):1100–5. doi: 10.1161/01.CIR.0000157153.30978.67. [DOI] [PubMed] [Google Scholar]
  • 16.Cappato Riccardo, Calkins Hugh, Chen Shih-Ann, Davies Wyn, Iesaka Yoshito, Kalman Jonathan, Kim You-Ho, Klein George, Natale Andrea, Packer Douglas, Skanes Allan, Ambrogi Federico, Biganzoli Elia. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010 Feb;3 (1):32–8. doi: 10.1161/CIRCEP.109.859116. [DOI] [PubMed] [Google Scholar]
  • 17.Calkins Hugh, Kuck Karl Heinz, Cappato Riccardo, Brugada Josep, Camm A John, Chen Shih-Ann, Crijns Harry J G, Damiano Ralph J, Davies D Wyn, DiMarco John, Edgerton James, Ellenbogen Kenneth, Ezekowitz Michael D, Haines David E, Haissaguerre Michel, Hindricks Gerhard, Iesaka Yoshito, Jackman Warren, Jalife José, Jais Pierre, Kalman Jonathan, Keane David, Kim Young-Hoon, Kirchhof Paulus, Klein George, Kottkamp Hans, Kumagai Koichiro, Lindsay Bruce D, Mansour Moussa, Marchlinski Francis E, McCarthy Patrick M, Mont J Lluis, Morady Fred, Nademanee Koonlawee, Nakagawa Hiroshi, Natale Andrea, Nattel Stanley, Packer Douglas L, Pappone Carlo, Prystowsky Eric, Raviele Antonio, Reddy Vivek, Ruskin Jeremy N, Shemin Richard J, Tsao Hsuan-Ming, Wilber David. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012 Apr;9 (4):632–696.e21. doi: 10.1016/j.hrthm.2011.12.016. [DOI] [PubMed] [Google Scholar]
  • 18.Oral Hakan, Pappone Carlo, Chugh Aman, Good Eric, Bogun Frank, Pelosi Frank, Bates Eric R, Lehmann Michael H, Vicedomini Gabriele, Augello Giuseppe, Agricola Eustachio, Sala Simone, Santinelli Vincenzo, Morady Fred. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N. Engl. J. Med. 2006 Mar 2;354 (9):934–41. doi: 10.1056/NEJMoa050955. [DOI] [PubMed] [Google Scholar]
  • 19.Go A S, Hylek E M, Phillips K A, Chang Y, Henault L E, Selby J V, Singer D E. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001 May 9;285 (18):2370–5. doi: 10.1001/jama.285.18.2370. [DOI] [PubMed] [Google Scholar]
  • 20.Miyasaka Yoko, Barnes Marion E, Gersh Bernard J, Cha Stephen S, Bailey Kent R, Abhayaratna Walter P, Seward James B, Tsang Teresa S M. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006 Jul 11;114 (2):119–25. doi: 10.1161/CIRCULATIONAHA.105.595140. [DOI] [PubMed] [Google Scholar]
  • 21.Magnani Jared W, Rienstra Michiel, Lin Honghuang, Sinner Moritz F, Lubitz Steven A, McManus David D, Dupuis Josée, Ellinor Patrick T, Benjamin Emelia J. Atrial fibrillation: current knowledge and future directions in epidemiology and genomics. Circulation. 2011 Nov 1;124 (18):1982–93. doi: 10.1161/CIRCULATIONAHA.111.039677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Benjamin E J, Levy D, Vaziri S M, D'Agostino R B, Belanger A J, Wolf P A. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994 Mar 16;271 (11):840–4. [PubMed] [Google Scholar]
  • 23.Feinberg W M, Blackshear J L, Laupacis A, Kronmal R, Hart R G. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch. Intern. Med. 1995 Mar 13;155 (5):469–73. [PubMed] [Google Scholar]
  • 24.Naccarelli Gerald V, Varker Helen, Lin Jay, Schulman Kathy L. Increasing prevalence of atrial fibrillation and flutter in the United States. Am. J. Cardiol. 2009 Dec 1;104 (11):1534–9. doi: 10.1016/j.amjcard.2009.07.022. [DOI] [PubMed] [Google Scholar]
  • 25.Hnatkova K, Waktare J E, Murgatroyd F D, Guo X, Camm A J, Malik M. Age and gender influences on rate and duration of paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 1998 Nov;21 (11 Pt 2):2455–8. doi: 10.1111/j.1540-8159.1998.tb01200.x. [DOI] [PubMed] [Google Scholar]
  • 26.Ong Lephuong, Irvine Jane, Nolan Robert, Cribbie Robert, Harris Louise, Newman David, Mangat Iqwal, Dorian Paul. Gender differences and quality of life in atrial fibrillation: the mediating role of depression. J Psychosom Res. 2006 Dec;61 (6):769–74. doi: 10.1016/j.jpsychores.2006.08.003. [DOI] [PubMed] [Google Scholar]
  • 27.Rodriguez I, Kilborn M J, Liu X K, Pezzullo J C, Woosley R L. Drug-induced QT prolongation in women during the menstrual cycle. JAMA. 2001 Mar 14;285 (10):1322–6. doi: 10.1001/jama.285.10.1322. [DOI] [PubMed] [Google Scholar]
  • 28.Pratt C M, Camm A J, Cooper W, Friedman P L, MacNeil D J, Moulton K M, Pitt B, Schwartz P J, Veltri E P, Waldo A L. Mortality in the Survival With ORal D-sotalol (SWORD) trial: why did patients die? Am. J. Cardiol. 1998 Apr 1;81 (7):869–76. doi: 10.1016/s0002-9149(98)00006-x. [DOI] [PubMed] [Google Scholar]
  • 29.Lehmann M H, Hardy S, Archibald D, quart B, MacNeil D J. Sex difference in risk of torsade de pointes with d,l-sotalol. Circulation. 1996 Nov 15;94 (10):2535–41. doi: 10.1161/01.cir.94.10.2535. [DOI] [PubMed] [Google Scholar]
  • 30.Burke J H, Ehlert F A, Kruse J T, Parker M A, Goldberger J J, Kadish A H. Gender-specific differences in the QT interval and the effect of autonomic tone and menstrual cycle in healthy adults. Am. J. Cardiol. 1997 Jan 15;79 (2):178–81. doi: 10.1016/s0002-9149(96)00707-2. [DOI] [PubMed] [Google Scholar]
  • 31.Nakagawa Mikiko, Ooie Tatsuhiko, Takahashi Naohiko, Taniguchi Yayoi, Anan Futoshi, Yonemochi Hidetoshi, Saikawa Tetsunori. Influence of menstrual cycle on QT interval dynamics. Pacing Clin Electrophysiol. 2006 Jun;29 (6):607–13. doi: 10.1111/j.1540-8159.2006.00407.x. [DOI] [PubMed] [Google Scholar]
  • 32.Forleo Giovanni B, Tondo Claudio, De Luca Lucia, Dello Russo Antonio, Casella Michela, De Sanctis Valerio, Clementi Fabrizio, Fagundes Rafael Lopes, Leo Roberto, Romeo Francesco, Mantica Massimo. Gender-related differences in catheter ablation of atrial fibrillation. Europace. 2007 Aug;9 (8):613–20. doi: 10.1093/europace/eum144. [DOI] [PubMed] [Google Scholar]
  • 33.Patel Dimpi, Mohanty Prasant, Di Biase Luigi, Sanchez Javier E, Shaheen Mazen H, Burkhardt J David, Bassouni Mohammed, Cummings Jennifer, Wang Yan, Lewis William R, Diaz Alberto, Horton Rodney P, Beheiry Salwa, Hongo Richard, Gallinghouse G Joseph, Zagrodzky Jason D, Bailey Shane M, Al-Ahmad Amin, Wang Paul, Schweikert Robert A, Natale Andrea. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm. 2010;7 (2):167–72. doi: 10.1016/j.hrthm.2009.10.025. [DOI] [PubMed] [Google Scholar]
  • 34.Zhang Xiao-Dong, Tan Hong-Wei, Gu Jun, Jiang Wei-Feng, Zhao Liang, Wang Yuan-Long, Liu Yu-Gang, Zhou Li, Gu Jia-Ning, Liu Xu. Efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation in women. Pacing Clin Electrophysiol. 2013 Oct;36 (10):1236–44. doi: 10.1111/pace.12212. [DOI] [PubMed] [Google Scholar]
  • 35.Takigawa Masateru, Kuwahara Taishi, Takahashi Atsushi, Watari Yuji, Okubo Kenji, Takahashi Yoshihide, Takagi Katsumasa, Kuroda Shunsuke, Osaka Yuki, Kawaguchi Naohiko, Yamao Kazuya, Nakashima Emiko, Sugiyama Tomoyo, Akiyama Daiki, Kamiishi Tetsuo, Kimura Shigeki, Hikita Hiroyuki, Hirao Kenzo, Isobe Mitsuaki. Differences in catheter ablation of paroxysmal atrial fibrillation between males and females. Int. J. Cardiol. 2013 Oct 3;168 (3):1984–91. doi: 10.1016/j.ijcard.2012.12.101. [DOI] [PubMed] [Google Scholar]
  • 36.Pappone Carlo, Augello Giuseppe, Sala Simone, Gugliotta Filippo, Vicedomini Gabriele, Gulletta Simone, Paglino Gabriele, Mazzone Patrizio, Sora Nicoleta, Greiss Isabelle, Santagostino Andreina, LiVolsi Laura, Pappone Nicola, Radinovic Andrea, Manguso Francesco, Santinelli Vincenzo. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J. Am. Coll. Cardiol. 2006 Dec 5;48 (11):2340–7. doi: 10.1016/j.jacc.2006.08.037. [DOI] [PubMed] [Google Scholar]
  • 37.Wazni Oussama M, Marrouche Nassir F, Martin David O, Verma Atul, Bhargava Mandeep, Saliba Walid, Bash Dianna, Schweikert Robert, Brachmann Johannes, Gunther Jens, Gutleben Klaus, Pisano Ennio, Potenza Dominico, Fanelli Raffaele, Raviele Antonio, Themistoclakis Sakis, Rossillo Antonio, Bonso Aldo, Natale Andrea. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005 Jun 1;293 (21):2634–40. doi: 10.1001/jama.293.21.2634. [DOI] [PubMed] [Google Scholar]
  • 38.Jaïs Pierre, Cauchemez Bruno, Macle Laurent, Daoud Emile, Khairy Paul, Subbiah Rajesh, Hocini Mélèze, Extramiana Fabrice, Sacher Fréderic, Bordachar Pierre, Klein George, Weerasooriya Rukshen, Clémenty Jacques, Haïssaguerre Michel. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008 Dec 9;118 (24):2498–505. doi: 10.1161/CIRCULATIONAHA.108.772582. [DOI] [PubMed] [Google Scholar]
  • 39.Packer Douglas L, Kowal Robert C, Wheelan Kevin R, Irwin James M, Champagne Jean, Guerra Peter G, Dubuc Marc, Reddy Vivek, Nelson Linda, Holcomb Richard G, Lehmann John W, Ruskin Jeremy N. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J. Am. Coll. Cardiol. 2013 Apr 23;61 (16):1713–23. doi: 10.1016/j.jacc.2012.11.064. [DOI] [PubMed] [Google Scholar]
  • 40.Krittayaphong Rungroj, Raungrattanaamporn Ongkarn, Bhuripanyo Kiertijai, Sriratanasathavorn Charn, Pooranawattanakul Sukanya, Punlee Kesaree, Kangkagate Charuwan. A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. J Med Assoc Thai. 2003 May;86 Suppl 1:S8–16. [PubMed] [Google Scholar]
  • 41.Stabile Giuseppe, Bertaglia Emanuele, Senatore Gaetano, De Simone Antonio, Zoppo Franco, Donnici Giovanni, Turco Pietro, Pascotto Pietro, Fazzari Massimo, Vitale Dino Franco. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur. Heart J. 2006 Jan;27 (2):216–21. doi: 10.1093/eurheartj/ehi583. [DOI] [PubMed] [Google Scholar]
  • 42.Wilber David J, Pappone Carlo, Neuzil Petr, De Paola Angelo, Marchlinski Frank, Natale Andrea, Macle Laurent, Daoud Emile G, Calkins Hugh, Hall Burr, Reddy Vivek, Augello Giuseppe, Reynolds Matthew R, Vinekar Chandan, Liu Christine Y, Berry Scott M, Berry Donald A. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010 Jan 27;303 (4):333–40. doi: 10.1001/jama.2009.2029. [DOI] [PubMed] [Google Scholar]
  • 43.Roten Laurent, Rimoldi Stefano F, Schwick Nicola, Sakata Takao, Heimgartner Chris, Fuhrer Juerg, Delacrétaz Etienne, Tanner Hildegard. Gender differences in patients referred for atrial fibrillation management to a tertiary center. Pacing Clin Electrophysiol. 2009 May;32 (5):622–6. doi: 10.1111/j.1540-8159.2009.02335.x. [DOI] [PubMed] [Google Scholar]
  • 44.Bonanno Carlo, Paccanaro Mariemma, La Vecchia Luigi, Ometto Renato, Fontanelli Alessandro. Efficacy and safety of catheter ablation versus antiarrhythmic drugs for atrial fibrillation: a meta-analysis of randomized trials. J Cardiovasc Med (Hagerstown) 2010 Jun;11 (6):408–18. doi: 10.2459/JCM.0b013e328332e926. [DOI] [PubMed] [Google Scholar]
  • 45.Nair Girish M, Nery Pablo B, Diwakaramenon Syamkumar, Healey Jeffrey S, Connolly Stuart J, Morillo Carlos A. A systematic review of randomized trials comparing radiofrequency ablation with antiarrhythmic medications in patients with atrial fibrillation. J. Cardiovasc. Electrophysiol. 2009 Feb;20 (2):138–44. doi: 10.1111/j.1540-8167.2008.01285.x. [DOI] [PubMed] [Google Scholar]
  • 46.Piccini Jonathan P, Lopes Renato D, Kong Melissa H, Hasselblad Vic, Jackson Kevin, Al-Khatib Sana M. Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol. 2009 Dec;2 (6):626–33. doi: 10.1161/CIRCEP.109.856633. [DOI] [PubMed] [Google Scholar]
  • 47.Noheria Amit, Kumar Abhishek, Wylie John V, Josephson Mark E. Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch. Intern. Med. 2008 Mar 24;168 (6):581–6. doi: 10.1001/archinte.168.6.581. [DOI] [PubMed] [Google Scholar]
  • 48.Ganesan Anand N, Shipp Nicholas J, Brooks Anthony G, Kuklik Pawel, Lau Dennis H, Lim Han S, Sullivan Thomas, Roberts-Thomson Kurt C, Sanders Prashanthan. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013 Mar 18;2 (2):e004549. doi: 10.1161/JAHA.112.004549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Deshmukh Abhishek, Patel Nileshkumar J, Pant Sadip, Shah Neeraj, Chothani Ankit, Mehta Kathan, Grover Peeyush, Singh Vikas, Vallurupalli Srikanth, Savani Ghanshyambhai T, Badheka Apurva, Tuliani Tushar, Dabhadkar Kaustubh, Dibu George, Reddy Y Madhu, Sewani Asif, Kowalski Marcin, Mitrani Raul, Paydak Hakan, Viles-Gonzalez Juan F. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013 Nov 5;128 (19):2104–12. doi: 10.1161/CIRCULATIONAHA.113.003862. [DOI] [PubMed] [Google Scholar]
  • 50.Balk Ethan M, Garlitski Ann C, Alsheikh-Ali Alawi A, Terasawa Teruhiko, Chung Mei, Ip Stanley. Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review. J. Cardiovasc. Electrophysiol. 2010 Nov;21 (11):1208–16. doi: 10.1111/j.1540-8167.2010.01798.x. [DOI] [PubMed] [Google Scholar]
  • 51.Heist E Kevin, Chalhoub Fadi, Barrett Conor, Danik Stephan, Ruskin Jeremy N, Mansour Moussa. Predictors of atrial fibrillation termination and clinical success of catheter ablation of persistent atrial fibrillation. Am. J. Cardiol. 2012 Aug 15;110 (4):545–51. doi: 10.1016/j.amjcard.2012.04.028. [DOI] [PubMed] [Google Scholar]
  • 52.Liu Xingpeng, Dong Jianzeng, Mavrakis Hercules E, Hu Fuli, Long Deyong, Fang Dongping, Yu Ronghui, Tang Ribo, Hao Peng, Lu Chunshan, He Xiaokui, Liu Xiaohui, Vardas Panos E, Ma Changsheng. Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: a randomized comparison between two different isolation approaches. J. Cardiovasc. Electrophysiol. 2006 Dec;17 (12):1263–70. doi: 10.1111/j.1540-8167.2006.00621.x. [DOI] [PubMed] [Google Scholar]
  • 53.Themistoclakis Sakis, Schweikert Robert A, Saliba Walid I, Bonso Aldo, Rossillo Antonio, Bader Giovanni, Wazni Oussama, Burkhardt David J, Raviele Antonio, Natale Andrea. Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation. Heart Rhythm. 2008 May;5 (5):679–85. doi: 10.1016/j.hrthm.2008.01.031. [DOI] [PubMed] [Google Scholar]
  • 54.Montefusco Antonio, Biasco Luigi, Blandino Alessandro, Cristoforetti Yvonne, Scaglione Marco, Caponi Domenico, Di Donna Paolo, Boffano Carlo, Cesarani Federico, Coin Daniele, Perversi Jacopo, Gaita Fiorenzo. Left atrial volume at MRI is the main determinant of outcome after pulmonary vein isolation plus linear lesion ablation for paroxysmal-persistent atrial fibrillation. J Cardiovasc Med (Hagerstown) 2010 Aug;11 (8):593–8. doi: 10.2459/JCM.0b013e32833831e4. [DOI] [PubMed] [Google Scholar]
  • 55.Naruse Yoshihisa, Tada Hiroshi, Sekiguchi Yukio, Machino Takeshi, Ozawa Mahito, Yamasaki Hiro, Igarashi Miyako, Kuroki Kenji, Itoh Yoko, Murakoshi Nobuyuki, Yamaguchi Iwao, Aonuma Kazutaka. Concomitant chronic kidney disease increases the recurrence of atrial fibrillation after catheter ablation of atrial fibrillation: a mid-term follow-up. Heart Rhythm. 2011 Mar;8 (3):335–41. doi: 10.1016/j.hrthm.2010.10.047. [DOI] [PubMed] [Google Scholar]
  • 56.Tokuda Michifumi, Yamane Teiichi, Matsuo Seiichiro, Ito Keiichi, Narui Ryohsuke, Hioki Mika, Tanigawa Shin-Ichi, Nakane Tokiko, Yamashita Seigo, Inada Keiichi, Shibayama Kenri, Miyanaga Satoru, Yoshida Hiroshi, Miyazaki Hidekazu, Date Taro, Yokoo Takashi, Yoshimura Michihiro. Relationship between renal function and the risk of recurrent atrial fibrillation following catheter ablation. Heart. 2011 Jan;97 (2):137–42. doi: 10.1136/hrt.2010.200824. [DOI] [PubMed] [Google Scholar]
  • 57.den Uijl Dennis W, Gawrysiak Marcin, Tops Laurens F, Trines Serge A, Zeppenfeld Katja, Schalij Martin J, Bax Jeroen J, Delgado Victoria. Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace. 2011 Nov;13 (11):1533–40. doi: 10.1093/europace/eur186. [DOI] [PubMed] [Google Scholar]
  • 58.Yagishita Atsuhiko, Takahashi Yoshihide, Takahashi Atsushi, Fujii Akira, Kusa Shigeki, Fujino Tadashi, Nozato Toshihiro, Kuwahara Taishi, Hirao Kenzo, Isobe Mitsuaki. Incidence of late thromboembolic events after catheter ablation of atrial fibrillation. Circ. J. 2011;75 (10):2343–9. doi: 10.1253/circj.cj-11-0065. [DOI] [PubMed] [Google Scholar]
  • 59.Hwang Hui-Jeong, Lee Man-Young, Youn Ho-Joong, Oh Yong-Seog, Rho Tae-Ho, Chung Wook-Sung, Park Chul-Soo, Choi Yun-Seok, Chung Woo-Baek, Lee Jae-Beom, Park Hyun-Keun, Lim Keunjoon, Lee Jae Hak. Association between plaque thickness of the thoracic aorta and recurrence of atrial fibrillation after ablation. Korean Circ J. 2011 Apr;41 (4):177–83. doi: 10.4070/kcj.2011.41.4.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Gertz Zachary M, Raina Amresh, Mountantonakis Stavros E, Zado Erica S, Callans David J, Marchlinski Francis E, Keane Martin G, Silvestry Frank E. The impact of mitral regurgitation on patients undergoing catheter ablation of atrial fibrillation. Europace. 2011 Aug;13 (8):1127–32. doi: 10.1093/europace/eur098. [DOI] [PubMed] [Google Scholar]
  • 61.Mohanty Sanghamitra, Mohanty Prasant, Di Biase Luigi, Rong Bai, Burkhardt David, Gallinghouse Joseph G, Horton Rodney, Sanchez Javier E, Bailey Shane, Zagrodzky Jason, Natale Andrea. Baseline B-type natriuretic peptide: a gender-specific predictor of procedure-outcome in atrial fibrillation patients undergoing catheter ablation. J. Cardiovasc. Electrophysiol. 2011 Aug;22 (8):858–65. doi: 10.1111/j.1540-8167.2011.02036.x. [DOI] [PubMed] [Google Scholar]
  • 62.Hu Ji-Qiang, Ma Jian, Ouyang Feifan, Yang Qian, Liao Zi-Li, Hou Yu, Zhang Shu. Is selective ipsilateral PV isolation sufficient for focally triggered paroxysmal atrial fibrillation? Comparison of selective ipsilateral pulmonary vein isolation versus bilateral pulmonary vein isolation. J. Cardiovasc. Electrophysiol. 2012 Feb;23 (2):130–6. doi: 10.1111/j.1540-8167.2011.02166.x. [DOI] [PubMed] [Google Scholar]
  • 63.Mulder Anton A W, Wijffels Maurits C E F, Wever Eric F D, Boersma Lucas V A. Freedom from paroxysmal atrial fibrillation after successful pulmonary vein isolation with pulmonary vein ablation catheter-phased radiofrequency energy: 2-year follow-up and predictors of failure. Europace. 2012 Jun;14 (6):818–25. doi: 10.1093/europace/eus010. [DOI] [PubMed] [Google Scholar]
  • 64.Pokushalov Evgeny, Romanov Alexander, Corbucci Giorgio, Bairamova Sevda, Losik Denis, Turov Alex, Shirokova Natalya, Karaskov Alexander, Mittal Suneet, Steinberg Jonathan S. Does atrial fibrillation burden measured by continuous monitoring during the blanking period predict the response to ablation at 12-month follow-up? Heart Rhythm. 2012 Sep;9 (9):1375–9. doi: 10.1016/j.hrthm.2012.03.047. [DOI] [PubMed] [Google Scholar]
  • 65.Park Yae M, Choi Jong-Il, Lim Hong E, Park Sang W, Kim Young-Hoon. Is pursuit of termination of atrial fibrillation during catheter ablation of great value in patients with longstanding persistent atrial fibrillation? J. Cardiovasc. Electrophysiol. 2012 Oct;23 (10):1051–8. doi: 10.1111/j.1540-8167.2012.02370.x. [DOI] [PubMed] [Google Scholar]
  • 66.Shim Jaemin, Joung Boyoung, Park Jae Hyung, Uhm Jae-Sun, Lee Moon-Hyoung, Pak Hui-Nam. Long duration of radiofrequency energy delivery is an independent predictor of clinical recurrence after catheter ablation of atrial fibrillation: over 500 cases experience. Int. J. Cardiol. 2013 Sep 10;167 (6):2667–72. doi: 10.1016/j.ijcard.2012.06.120. [DOI] [PubMed] [Google Scholar]
  • 67.Blanche Coralie, Tran Nam, Rigamonti Fabio, Burri Haran, Zimmermann Marc. Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace. 2013 Feb;15 (2):198–204. doi: 10.1093/europace/eus251. [DOI] [PubMed] [Google Scholar]
  • 68.Spragg David D, Dalal Darshan, Cheema Aamir, Scherr Daniel, Chilukuri Karuna, Cheng Alan, Henrikson Charles A, Marine Joseph E, Berger Ronald D, Dong Jun, Calkins Hugh. Complications of catheter ablation for atrial fibrillation: incidence and predictors. J. Cardiovasc. Electrophysiol. 2008 Jun;19 (6):627–31. doi: 10.1111/j.1540-8167.2008.01181.x. [DOI] [PubMed] [Google Scholar]
  • 69.Shoemaker M Benjamin, Muhammad Raafia, Farrell Maureen, Parvez Babar, White Brenda W, Streur Megan, Stubblefield Tanya, Rytlewski Jason, Parvathaneni Sunthosh, Nagarakanti Rangadham, Roden Dan M, Saavedra Pablo, Ellis Christopher, Whalen S Patrick, Darbar Dawood. Relation of morbid obesity and female gender to risk of procedural complications in patients undergoing atrial fibrillation ablation. Am. J. Cardiol. 2013 Feb 1;111 (3):368–73. doi: 10.1016/j.amjcard.2012.10.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70.Bertaglia Emanuele, Stabile Giuseppe, Pappone Alessia, Themistoclakis Sakis, Tondo Claudio, De Sanctis Valerio, Soldati Ezio, Tritto Massimo, Solimene Francesco, Grimaldi Massimo, Zoppo Franco, Pandozi Claudio, Augello Giuseppe, Calò Leonardo, Pappone Carlo. Updated national multicenter registry on procedural safety of catheter ablation for atrial fibrillation. J. Cardiovasc. Electrophysiol. 2013 Oct;24 (10):1069–74. doi: 10.1111/jce.12194. [DOI] [PubMed] [Google Scholar]
  • 71.Baman Timir S, Jongnarangsin Krit, Chugh Aman, Suwanagool Arisara, Guiot Aurelie, Madenci Arin, Walsh Spencer, Ilg Karl J, Gupta Sanjaya K, Latchamsetty Rakesh, Bagwe Suveer, Myles James D, Crawford Thomas, Good Eric, Bogun Frank, Pelosi Frank, Morady Fred, Oral Hakan. Prevalence and predictors of complications of radiofrequency catheter ablation for atrial fibrillation. J. Cardiovasc. Electrophysiol. 2011 Jun;22 (6):626–31. doi: 10.1111/j.1540-8167.2010.01995.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Hoyt Hana, Bhonsale Aditya, Chilukuri Karuna, Alhumaid Fawaz, Needleman Matthew, Edwards David, Govil Ashul, Nazarian Saman, Cheng Alan, Henrikson Charles A, Sinha Sunil, Marine Joseph E, Berger Ronald, Calkins Hugh, Spragg David D. Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors. Heart Rhythm. 2011 Dec;8 (12):1869–74. doi: 10.1016/j.hrthm.2011.07.025. [DOI] [PubMed] [Google Scholar]
  • 73.Shah Rashmee U, Freeman James V, Shilane David, Wang Paul J, Go Alan S, Hlatky Mark A. Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation. J. Am. Coll. Cardiol. 2012 Jan 10;59 (2):143–9. doi: 10.1016/j.jacc.2011.08.068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74.Siddharth P, Smith N L, Mason R A, Giron F. Variational anatomy of the deep femoral artery. Anat. Rec. 1985 Jun;212 (2):206–9. doi: 10.1002/ar.1092120216. [DOI] [PubMed] [Google Scholar]
  • 75.Schnyder G, Sawhney N, Whisenant B, Tsimikas S, Turi Z G. Common femoral artery anatomy is influenced by demographics and comorbidity: implications for cardiac and peripheral invasive studies. Catheter Cardiovasc Interv. 2001 Jul;53 (3):289–95. doi: 10.1002/ccd.1169. [DOI] [PubMed] [Google Scholar]
  • 76.Campbell N R, Hull R D, Brant R, Hogan D B, Pineo G F, Raskob G E. Different effects of heparin in males and females. Clin Invest Med. 1998 Apr;21 (2):71–8. [PubMed] [Google Scholar]
  • 77.Winkle Roger A, Mead R Hardwin, Engel Gregory, Patrawala Rob A. Safety of lower activated clotting times during atrial fibrillation ablation using open irrigated tip catheters and a single transseptal puncture. Am. J. Cardiol. 2011 Mar 1;107 (5):704–8. doi: 10.1016/j.amjcard.2010.10.048. [DOI] [PubMed] [Google Scholar]

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