Are there gender differences in outcomes after the Cox-Maze procedure for atrial fibrillation?
Abstract
OBJECTIVE: Atrial fibrillation (AF) management suggests that women do not tolerate medication rhythm control strategies as well as men do; however, AF percutaneous catheter ablation has been found to be favorable. The study purpose was to compare the sex-based outcomes for patients who undergo the Cox-Maze procedure for AF. METHODS: Data were collected through our AF surgical ablation registry. Rhythm was verified by electrocardiogram and 24-hour holter at 6 and 12 months. General health-related quality of life (Short-Form 12) and specific AF symptom burden (Atrial Fibrillation Symptom Checklist: Frequency and Severity, version 3) were obtained at baseline and 12 months. RESULTS: Since 2005, a total of 540 patients have undergone a Cox-Maze procedure (34% were women). The women presented with higher operative risk [additive European System for Cardiac Operative Risk Evaluation (EuroSCORE), 6.71 ± 2.61 vs 5.25 ± 2.80, t = 5.85, P < 0.001], higher rates of congestive heart failure (49% vs 32%, P < 0.001), and more concomitant mitral valve procedures (32% vs 19%, P = 0.001). Perioperative outcomes were similar. Return to sinus rhythm off antiarrhythmics were not different at 6 and 12 months (78% vs 75%, P = 0.53, and 81% vs 80%, P = 1.00, respectively). Cumulative 2-year survival (93.9% for the men and 89.3% for the women) was not different for all-cause mortality (hazard ratio, 1.47; confidence interval, 0.68-3.21; P = 0.33) and cardiac-related mortality [women: 10/14 (71%) vs men 7/11 (64%), P = 1.00]. Health-related quality of life showed significant improvement; AF symptoms significantly decreased across the sexes. CONCLUSIONS: Outcomes after the Cox-Maze procedure are similar across sex. Atrial fibrillation surgical ablation should be considered a treatment option for women-it is safe and effective, improves general health-related quality of life, and reduces AF symptom burden.
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Outcomes of catheter ablation or AF surgery are comparable in women and men.
“Bleeding risk on anticoagulation is similar in both sexes, 49,50,53 but women appear less likely to receive specialist care and rhythm control therapy, 54 while the outcomes of catheter ablation or AF surgery are comparable to those in men.55,56”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [56]
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- Authors
- Henry, L., Hunt, S., Holmes, S. D., Martin, L. M., & Ad, N.
- Affiliations
- Inova Health System (US)
- Corresponding author
- Henry, Linda
- Venue
- Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery
- Publisher
- SAGE Publications
- Published
- 2013-05
- Volume
- 8
- Issue
- 3
- Pages
- 190-198
- ISSN
- 1556-9845 (ISSN-L)
- 1559-0879
- OpenAlex
- W2326453756
- Cited by
- 17
- References
- 52
- Citations by year
- 2024: 2 · 2023: 2 · 2022: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 5 · 2015: 3
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, Cox-Maze procedure, surgical ablation, sex differences, women, health-related quality of life, sinus rhythm restoration, all-cause mortality, cardiovascular mortality, EuroSCORE, congestive heart failure, mitral valve surgery, perioperative outcomes, atrial fibrillation surgery
- MeSH terms
- Adult, Atrial Fibrillation, Electrocardiography, Female, Heart Atria, Heart Failure, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Sex Factors, Treatment Outcome
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