She is a 60-year old heart patient who wryly claims: “Catheter ablation is one of my favorite subjects!” After she underwent this treatment for her atrial fibrillation*, she healed surprisingly slowly, and her distressing episodes of high or irregular heart rate – averaging anywhere from 140-160 beats per minute – “came back full-time”.
She was also warned that these symptoms could last for months. She adds:
“I know how frustrating it is when doctors tell you that ablation is ‘The Answer’ and it turns out not to be.”
Sadly, she is not alone. Last year, cardiac researchers at St. David’s Hospital in Austin, Texas reported striking differences in the outcomes and complications of more than 3,200 women who underwent the cardiac procedure called Atrial Fibrillation Ablation*.
Cardiologist Dr. John Mandrola offers us highlights of the remarkable gender differences outlined in this study:
- Women underwent AF ablation five times less often than men.
- AF ablation was less successful in women.
- Women were older than men at the time of AF ablation.
- Women had failed more drugs than men before referral for ablation.
- Women had later stage AF at the time they were referred for ablation.
- Women were more likely to have atypical firing-sites (outside the pulmonary veins) for AF.
- Women had more bleeding complications after ablation.
Dr. Mandrola adds that such data are consistent with other well-known facts about heart disease in women.
- Women with AF are at greater risk for stroke than men. In fact, the association is so strong, European investigators give female gender a full point in their more detailed CHADS2-VASc score for predicting stroke in AF.
- Women are more susceptible to AF drugs, especially those that increase the time it takes the heart to relax. In other words, the electrical properties of the heart cell often vary by gender.
- The most common form of SVT (Supraventricular Tachycardia), AV Nodal Reentry (AVNRT) occurs more commonly in women.
- Women are under-referred for other innovative cardiac technologies like defibrillators, coronary artery bypass surgery and cardiac catheterization.
Meanwhile, after her first catheter ablation was not considered a success, our 60-year old AF patient has now been advised by her cardiologist to undergo another ablation procedure, this time at a different heart hospital.
This repeat recommendation is in line with research reported from France that found at least 50% of ablation patients have to undergo two procedures; about 20% have three or more procedures. Our patient says:
“I’m all for it. My A-fib symptoms were pretty much managed by my drugs, but aside from the recurring heart rhythm problems, I’m now experiencing serious drug side effects like blurred vision.”
Read the original journal abstract for this study, Outcomes and Complications of Catheter Ablation for Atrial Fibrillation in Females, published in the Heart Rhythm Journal, or Dr. John Mandrola’s article about the study.
* Atrial fibrillation (A-fib or AF) is defined as a common irregular heart rhythm affecting the heart’s upper chambers, causing unusual and often rapid heart rate that causes poor blood flow to the body. Although AF itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires treatment to alter the heart’s electrical system. One of those atrial fibrillation treatment options is called catheter ablation, an invasive procedure that uses a catheter to either burn or freeze specific heart tissue so the erratic electrical signals are normalized and the arrhythmia is corrected.
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