# Sex differences in procedural characteristics, safety, and clinical outcomes of pulsed field ablation for atrial fibrillation

## TL;DR

This study finds that female patients undergoing pulsed field ablation for atrial fibrillation experience longer procedures and higher recurrence rates compared to males.

## Contribution

The study provides novel sex-specific insights into pulsed field ablation outcomes for atrial fibrillation.

## Key findings

- Female patients had longer procedure times and higher arrhythmia recurrence rates compared to males.
- Complication rates were similar between sexes despite longer procedure times in females.
- Propensity score matching confirmed higher recurrence in women after one year.

## Abstract

Previous studies on pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) using conventional thermal techniques have shown inconsistent sex-related outcomes. Pulsed field ablation (PFA) is a novel energy source offering myocardial-selective ablation. However, sex-specific data on its performance are limited.

This study aimed to compare procedural characteristics, safety, and clinical outcomes of PFA in female and male patients undergoing AF ablation.

This prospective study included consecutive patients with paroxysmal or persistent AF undergoing PFA-based PVI using a pentaspline catheter. Follow-up was conducted at 3, 6, and 12 months. A 1:1 propensity score-matched cohort was created to evaluate sex-specific outcomes.

Among 425 patients, 134 (32%) were women. Compared with men, women were older (median 70 vs 65 years; P < .001), more frequently had paroxysmal AF (60% vs 45%; P = .006), and had lower rates of coronary artery disease (6% vs 14%; P = .029). Although overall procedural times were similar, female patients with paroxysmal AF had significantly longer procedure, left atrial dwell, and fluoroscopy times than males. Complication rates were comparable (1.5% in women vs 0.7% in men; P = .371). After propensity score matching (133 women to 133 men), arrhythmia recurrence at 1-year follow-up was higher in women (23% vs 12%; P = .017; hazard ratio 2.2; standard error 0.34).

Significant sex-related differences exist in clinical outcomes after PVI with PFA in AF. Further studies exploring underlying mechanisms and tailored approaches may enhance outcomes in female patients.