Sex-specific differences in left atrial reverse remodelling after successful catheter ablation for atrial fibrillation

AIMS: Left atrial reverse remodelling (LARR) following restoration of sinus rhythm is associated with favourable outcomes in patients with atrial fibrillation (AF). Female patients have a higher risk of recurrent AF after ablation therapy than males. This study evaluated sex-specific differences in LARR after successful ablation of AF. METHODS AND RESULTS: We examined 153 AF patients who underwent two-dimensional echocardiography before and 6 months after successful ablation without recurrent arrhythmia. LA reservoir strain (LARS) was assessed by speckle-tracking echocardiography, and LA stiffness was calculated using the ratio of E/e' to LARS. Clinical characteristics, type of AF, and baseline LA size and function were similar between males and females. At 6 months after ablation, LA parameters were improved in both sexes (all P < 0.05). Sex-specific differences in the changes of LA measures were assessed by linear mixed-effect model, and females showed significantly less improvement in LARS than males (ΔLARS: + 5.2% vs. + 9.2%, P = 0.011). In multivariable analyses for post-procedural LA indices, female sex was independently associated with larger LA volume index [unstandardized coefficient (B) = 1.35, P = 0.029], decreased LARS [unstandardized coefficient (B) = -1.33, P = 0.012] and greater LA stiffness [unstandardized coefficient (B) = 0.03, P = 0.003]. Despite similar B-type natriuretic peptide (BNP) levels at baseline, female patients had higher BNP concentration at follow-up (median 33.9 vs. 20.3 pg/mL, P = 0.004). CONCLUSION: LARR was attenuated in female AF patients, which might be related to unfavourable outcomes after ablation therapy. The relatively small number of female patients and short follow-up period in this study require further investigations.