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

Abstract Aims Left atrial reverse remodeling (LARR) following restoration of sinus rhythm is associated with favorable 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 unfavorable outcomes after ablation therapy. The relatively small number of female patients and short follow-up period in this study require further investigations.