Women with atrial fibrillation undergoing pulmonary vein isolation are more symptomatic but improve more in health-related quality of life and symptom burden than men

Figures & data

Table 1. Baseline characteristics of the study subjects.

	Total n = 242	Men n = 121	Women n = 121	p
Age	62 ± 9	60 ± 10	63 ± 9	0.01
Systolic blood pressure	132 ± 19	132 ± 17	132 ± 20	0.8
Diastolic blood pressure	76 ± 10	79 ± 10.1	76 ± 10	0.07
BMI	27 ± 4	27 ± 3	26 ± 4	0.3
	n (%)	n (%)	n (%)
Diagnosis
Paroxysmal atrial fibrillation	178 (74)	85 (70)	93 (77)	0.3
Persistent atrial fibrillation	64 (26)	36 (30)	28 (23)	0.2
Comorbidities
Hypertension	91 (38)	47 (39)	44 (36)	0.8
Heart disease^a	15 (6)	11 (9)	4 (3)	0.1
Heart failure	10 (4)	5 (4)	5(4)	1.0
Diabetes	16 (7)	12(10)	4 (3)	0.07
Stroke/transient ischemic attack	23 (10)	11 (9)	12 (10)	0.8
Chronic obstructive pulmonary disease	3 (1)	1 (<1)	2 (2)	0.6
Tested antiarrhythmic drugs
Amiodarone	30 (12)	11 (9)	19 (16)	0.2
Disopyramide	15 (6)	5 (4)	10 (8)	0.3
Dronedarone	111 (46)	55 (45)	57 (47)	0.9
Flecainide	95 (39)	57 (47)	41 (34)	0.05
Propaphenone	3 (1)	2 (2)	1 (<1)	0.6
Quinidine	2 (<1)	1 (<1)	1 (<1)	1.0
Sotalol	72 (30)	35 (29)	38 (31)	0.8
Others
Beta-blockers	181 (75)	84 (69)	99 (81)	0.04
Calcium channel blockers	16 (7)	3 (2)	13 (11)	0.02
Digoxin	24 (10)	4 (3)	20 (17)	0.001
Marital status and socioeconomic data
Married	192 (79)	107 (88)	85 (70)	<0.001
Single	39 (16)	11 (9)	28 (23)	0.005
Widowed	8 (3)	1 (<1)	8 (7)	0.04
Unknown	3 (1)	2 (2)	1 (<1)	0.6
Education level
Primary	33 (14)	16 (13)	18 (15)	0.9
High school	74 (31)	36 (30)	38 (31)	0.9
University/College	120 (50)	59 (49)	61 (50)	0.9
Unknown	14 (6)	10 (8)	4 (3)	0.2
Occupational status
Employed or self-employed	106 (44)	37 (31)	69 (57)	<0.001
Temporary worker, hourly employee, unemployed	11 (5)	4 (3)	7 (6)	0.5
Retired	97 (40)	39 (32)	58 (48)	0.02
Long-term sick leave^b	7 (3)	2 (2)	5(4)	0.4

^aCoronary artery disease, valvular heart disease, coronary bypass surgery.

^bMore than 3 months, disability leave.

Table 2. Ablation data.

	Men n = 121	Women n = 121	p
Duration of ablation procedure, min	182 ± 53	164 ± 55	0.01
X-ray, min	25 ± 14	21 ± 11	0.03
Hospitalization duration, days	1.1 ± 0.6	1.3 ± 0.6	0.8
Anesthetic	0	4 (3)	0.1
Types of procedure
Radiofrequency energy	90 (75)	93 (77)	0.8
Cryo thermal energy	30 (25)	27 (23)	0.8
Pulmonary vein isolation only	94 (78)	107 (89)	0.04
Pulmonary vein isolation with substrate modification	26 (22)	13 (11)	0.04
Interrupted ablation	1 (<1)	1 (<1)	1.0

Data are presented as mean SD, or number and percentage.

Table 3. Results from the questionnaire regarding the patients’ own experience of the AF, symptom duration and referral history.

	Men (n = 121)	Women (n = 121)	p
Questions and claims
How many years have you had symptomatic AF?	6 ± 6	6 ± 5	0.9
Correct diagnosis at the first consultation	81(67)	72(60)	0.3
Have never felt any palpitation	20 (17)	8 (7)	0.03
Experience at the outpatient’s clinic
How many times did you visit the GP, occupational health service, or cardiologist due to the AF?	3 ± 6	3 ± 4	0.3
How many times did you visit the Emergency care due to the AF?	5 ± 7	4 ± 5	0.2
I didn’t feel that the health care staff believed in me when I consulted for my arrhythmia symptom.	9 (7)	12 (10)	0.6
I feel that I have been incorrectly diagnosed.	3 (2)	4 (3)	0.7
Experiences of the referral
Referral for ablation at first consultation	5 (4)	1 (<1)	0.2
I accepted instantly when I was offered PVI ablation for my AF	90 (74)	89 (74)	0.9
I had wished to be referred for ablation earlier	41 (34)	37 (31)	0.7
I had to ask for referral of ablation myself	24 (20)	33 (27)	0.2
I was offered a referral for ablation but chose to wait	13 (11)	11 (9)	0.8
Number of times you have been converted, mean SD	4 ± 5	2 ± 3	0.001
When you had received the correct diagnosis, what treatment were you offered?
Drug therapy	59 (49)	80 (66)	0.009
Drug therapy and conversion	67 (55)	52 (43)	0.07
Drug therapy while waiting for ablation	41 (34)	30 (25)	0.2
Ablations treatment directly	5 (4)	1 (<1)	0.2
Information about AF
I would have liked more or better information about AF	74 (61)	102 (84)	<0.001
Yes, I got enough information about AF	39 (32)	18 (15)	0.002
Unknown	8 (7)	1 (<1)	0.04
Information of how to act if a new episode occurs
Felt well informed about how to react if a new AF episode should occur	40 (33)	38 (31)	0.9
I needed no information	36 (30)	30 (25)	0.5
No, would have liked more information	32 (26)	50 (39)	0.02
Unknown/ no answer	13 (8)	3 (2)	0.02

AF, atrial fibrillation.

Data are presented as mean SD or n (%), p value <0.05 was considered significant.

Table 4. Symptoms and Functional impairment pre- and post PVI, comparison between the sexes.

Symptom checklist	Baseline			6 months
	Men n = 121	Women n = 121	P	Men n = 107	Women n = 114	p
Frequency	15.5 ± 8.6	24.4 ± 9.1	<0.001	10.8 ± 7.8	15.1 ± 9.4	<0.001
Severity	13.1 ± 7.5	20.2 ± 7.6	<0.001	9.1 ± 6.5	12.4 ± 7.3	<0.001
A higher score indicates more symptoms
SF-36 dimensions
Physical functioning	80.1 ± 17.9	64.1 ± 22.8	<0.001	94.3 ± 90.5	76.5 ± 20.9	0.05
Role physical	55.2 ± 39.8	36.0 ± 43.3	<0.001	76.6 ± 35.4	66.0 ± 43.0	0.05
Bodily pain	76.0 ± 24.1	64.7 ± 27.5	0.001	82.2 ± 23.4	76.5 ± 24.6	0.08
General health	61.4 ± 19.1	56.4 ± 21.2	0.05	69.5 ± 21.9	66.1 ± 21.8	0.2
Vitality	53.3 ± 21.7	46.0 ± 22.7	0.01	65.5 ± 21.9	63.3 ± 22.5	0.5
Social functioning	76.7 ± 23.3	61.3 ± 28.3	<0.001	87.5 ± 21.0	84.0 ± 22.5	0.2
Role emotional	73.9 ± 38.2	60.6 ± 44.2	0.01	84.3 ± 29.4	81.0 ± 36.0	0.5
Mental health	74.1 ± 18.0	66.9 ± 20.6	0.004	79.9 ± 18.3	77.9 ± 17.7	0.4
A higher score indicates better HRQOL
Sickness Impact Profile Dimensions^a
Physical
Ambulation	2.2 ± 1.3	3.5 ± 1.8	<0.001	2.1 ± 1.1	2.6 ± 1.8	0.1
Mobility	1.6 ± 0.5	3.1 ± 2.1	<0.001	1.9 ± 1.0	2.9 ± 2.2	0.1
Psychosocial
Social interaction	2.0 ± 1.8	3.1 ± 2.4	0.002	1.7 ± 1.7	2.1 ± 2.0	0.2
Alertness behavior	3.4 ± 2.8	3.7 ± 2.7	0.6	3.3 ± 3.1	3.2 ± 2.3	0.9
Emotional behavior	2.7 ± 2.1	3.2 ± 1.9	0.3	2.6 ± 1.9	2.9 ± 1.7	0.5
Communication	1.9 ± 0.9	2.2 ± 1.2	0.5	1.8 ± 0.7	2.1 ± 1.0	0.4
Independent categories
Sleep and rest	4.1 ± 2.5	4.0 ± 2.1	0.9	3.4 ± 2.2	3.1 ± 1.9	0.4
Home management	2.7 ± 1.7	4.4 ± 2.5	<0.001	2.9 ± 1.5	3.9 ± 2.6	0.1
Recreation and Pastimes	2.7 ± 1.7	3.5 ± 1.9	0.007	2.8 ± 1.6	3.4 ± 1.8	0.1

^aExcluded items: work and food intake. Higher score indicates poorer functional impairment.

Data are presented as mean ± SD, p value <0.05 was considered significant.

Table 5. Improvement related to success of AF ablation.

SF-36	Baseline			6 months			Baseline	6 months			6 months
	Complete freedom from AF	AF recurrences		Complete freedom from AF	AF recurrences		Complete freedom from AF	Complete freedom from AF		Baseline AF recurrences	AF recurrences
Dimensions	n = 137	n = 104	p	n = 127	n = 94	p	n = 127	n = 127	p	n = 94	n = 94	p
Physical functioning	76.1 ± 19.8	66.7 ± 23.6	0.001	87.4 ± 16.5	72.4 ± 22.1	<0.001	76.2 ± 19.9	87.4 ± 16.5	<0.001	66.7 ± 22.2	72.4 ± 22.1	0.01
Role physical	49.6 ± 44.2	40.1 ± 39.9	0.08	82.9 ± 31.4	55.3 ± 44.3	<0.001	51.2 ± 44.2	82.9 ± 31.4	<0.001	39.4 ± 39.6	55.3 ± 44.3	0.002
Bodily pain	72.0 ± 26.6	68.1 ± 26.1	0.3	81.8 ± 23.6	75.8 ± 24.7	0.07	72.6 ± 26.5	81.8 ± 23.6	<0.001	67.8 ± 26.3	75.8 ± 24.7	0.004
General health	61.7 ± 18.9	55.2 ± 21.6	0.02	74.5 ± 18.6	58.6 ± 22.6	<0.001	61.8 ± 18.7	74.5 ± 18.6	<0.001	55.4 ± 21.5	58.6 ± 22.6	0.1
Vitality	50.9 ± 22.8	48.0 ± 22.1	0.3	70.5 ± 19.9	56.1 ± 22.5	<0.001	51.4 ± 22.7	70.5 ± 19.9	<0.001	48.1 ± 21.0	56.1 ± 22.5	0.001
Social functioning	70.0 ± 28.1	67.5 ± 25.6	0.5	90.9 ± 17.9	78.6 ± 24.6	<0.001	70.6 ± 28.0	90.9 ± 17.9	<0.001	68.1 ± 25.4	78.6 ± 24.6	<0.001
Role emotional	70.8 ± 40.3	62.6 ± 43.4	0.1	89.9 ± 25.6	72.7 ± 38.8	<0.001	72.5 ± 39.3	90.1 ± 25.7	<0.001	63.6 ± 42.8	72.7 ± 38.8	0.04
Mental health	70.9 ± 19.4	69.9 ± 20.1	0.7	82.3 ± 16.4	74.3 ± 19.0	0.001	71.3 ± 19.5	82.3 ± 16.4	<0.001	70.7 ± 18.1	74.3 ± 19.0	0.07

Data are presented as mean ± SD. A higher value indicates better HRQOL.

Table 6. Differences in HRQOL between ablation success in persistent and PAF patients.

Persistent atrial fibrillation								PAF atrial fibrillation
SF-36	Baseline	6 months		6 month			SF-36		Baseline			6 month
Dimensions	n = 3			n = 28			Dimensions		n = 9			n = 65
	AF success	AF success	p value	AF not success	AF not success	p value			AF success	AF success	p value	AF not success	AF not success	p value
Physical functioning	70.9 ± 20	85.6 ± 18	<0.001	63.2 ± 19	73.6 ± 20	0.025	Physical functioning		77.9 ± 20	88.0 ± 16	<0.001	68.1 ± 23	72.3 ± 23	0.1
Role physical	44.4 ± 44	79.8 ± 34	0.001	29.5 ± 37	51.8 ± 44	0.05	Role physical		53.4 ± 45	83.9 ± 31	<0.001	43.5 ± 41	57.7 ± 45	0.009
Bodily pain	81.5 ± 24	81.5 ± 25	1	71.0 ± 26	77.8 ± 22	0.3	Bodily pain		69.8 ± 27	81.9 ± 23	<0.001	66.4 ± 27	75.1 ± 26	0.005
General health	64.4 ± 19	74.7 ± 18	0.005	52.2 ± 24	55.4 ± 24	0.6	General health		61.0 ± 19	74.4 ± 19	<0.001	56.3 ± 20	60.3 ± 22	0.06
Vitality	54.2 ± 19	72.0± 20	<0.001	43.9 ± 16	59.1 ± 22	0.004	Vitality		50.6 ± 24	70.0 ± 20	<0.001	49.6 ± 23	54.8 ± 23	0.04
Social functioning	72.6 ± 26	89.9± 18	0.003	62.9 ± 24	79.9 ± 22	0.004	Social functioning		69.9 ± 29	91.3 ± 18	<0.001	69.8 ± 26.0	78.3 ± 26	0.002
Role emotional	83.3 ± 32	88.9 ± 25	0.3	51.5 ± 44	73.8 ± 41	0.004	Role emotional		69 ± 41	90.5 ± 26	<0.001	68.2 ± 42	72.8 ± 38	0.4
Mental health	68.3 ± 21	79.9 ± 19	0.002	70.0 ± 18	75.3 ± 20	0.2	Mental health		72.3 ± 19	83.1 ± 15	<0.001	70.6 ± 19	73.7 ± 19	0.1

Data are presented as mean ± SD. A higher value indicate better HRQOL.