Why are women with atrial fibrillation treated differently?

15 Apr

by Carolyn Thomas 

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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4 Responses to “Why are women with atrial fibrillation treated differently?”

  1. jeffrey lee July 7, 2011 at 11:23 am #

    Women With Atrial Fibrillation Are At Significantly Higher Risk Of Stroke And Death Compared To Men. Even though the incidence of atrial fibrillation is higher in men than women, a review of past studies and medical literature completed by cardiac experts at Rush University Medical Center shows that women are more likely than men to experience symptomatic attacks, a higher frequency of recurrences, and significantly higher heart rates during atrial fibrillation, which increases the risk of stroke.

    I do have a personal Question: Is there any natural method to prevent Atrial Fibrillation. If yes please let me know.

    Like

  2. Dr. Ruth Simkin April 15, 2011 at 11:49 am #

    So WHY are women treated differently? This explains THAT women are treated differently but doesn’t really explain WHY women are treated differently.

    If a man and a woman each present at Emerg in AF, what is it about being a woman that will give that patient different treatment than the man?

    Like

    • Dr. John Mandrola April 17, 2011 at 6:12 am #

      Hey Dr Simkin,

      Let me take a swing at answering your questions. First off, the easier answer: In the emergency department, most would agree that all AF, be it in a male or female, looks the same. ER doctors are charged with starting supportive care measures like controlling the high rates of AF with rate-slowing medicines (B-blockers, Ca-Entry blockers or digoxin), treating fluid build-up with diuretics and supporting breathing with oxygen. They often start the blood-thinning medicine as well. In my experience, these basic maneuvers are not gender-specific.

      Your first question, however, is the vexing one. “Why are women treated differently?” Why, for instance, do women get fewer ablations, present later in the course of their illness, and have more non-pulmonary vein triggers–which of course, makes them less responsive to the standard ablation lesion set?

      The answer is not known. All we have is speculation.

      I am in the process at looking back at my procedure spreadsheets, and have surprisingly found that I too, ablate far fewer women. And, some of my most difficult cases–where AF just will not seem to go away — are in women. There’s something different about the female atria.

      Here’s the important message for now: Knowing that there is a difference is critical.

      For women patients, they need to know if they develop AF, it might be harder to treat. Thus, prevention and intervention at an earlier stage is paramount. For doctors, understanding these gender issues may help us better treat our female patients. We might recommend more aggressive and earlier intervention, or on the other hand, we might advise a women in later stage AF of the more difficult road ahead. And for the scientists, it’s clear that clinical trials composed mainly of men are not generalizable to women.

      Hope this helps,

      Best,

      John

      Liked by 1 person

      • Carolyn Thomas April 17, 2011 at 6:27 am #

        Thanks Dr. John for your thoughtful response to Dr. Ruth!

        Like

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