Dr John M

cardiac electrophysiologist, cyclist, learner

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Atrial fibrillation ablation in women…Are there any real differences?

March 5, 2010 By Dr John

We all know that women have kinder hearts than do men. That’s an easy one.

But what about their cardiac electrical system?

The headline in the subject line of the email reads, AFib Ablation in Women: Are We Undertreating? I looked at this study a number of days ago, and initially thought–except for the number of co-authors–that nothing was remarkable. It was a retrospective study from only a handful of centers. AF-ablation in females had lower success rates, but in this study, women had more advanced AF, and so it follows that ablation proved less successful.

Are there differences in treating heart disease in men and women?
Yes, yes and yes!  Drug metabolism, susceptibility to QT prolongation and a higher stroke risk in women with AF are a few of said differences.
However, after fifteen years of treating AF, I can safely and unequivocally say, my recommendation for referral for an interventional procedure has never been affected by a patient’s gender –not even close.
To illustrate the gender neutrality of AF ablation, I present exhibit A –a left atrial (LA) lesion set for pulmonary vein isolation.
Can you tell the patient’s gender?  The answer is no.  PV isolation proceeds in the same way, whether male or female.

Women with AF require vigilance with rhythm drugs, blood-thinning when risk appropriate, and ablation when drug refractory, but so do men.

I revel in good science, read it enthusiastically, often with a trace of envy, and spread the word to colleagues and patients alike.  We, in the world of clinical medicine are guided by these studies, but we must read the data with a critical eye and consider real-world applicability. Prospective data that looks forward rather than backward, will help us better treat both women and men with AF.

A master of the obvious whose life is run by women is clear on the many differences between women and men, but to date, AF therapy done by me remains gender neutral.

When gender specific medicine or ablations are proven effective, I will holler loudly.

JMM

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Related posts:

  1. Atrial fibrillation therapy and a disclaimer…
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Filed Under: AF ablation, Atrial fibrillation, General Ablation Tagged With: Women's Heart disease

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

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