Sex-dependent differences in clinical characteristics and procedural outcome for patients admitted for catheter ablation of premature ventricular complexes

Prevalence and response to treatment of arrhythmias are different for women and men. We characterized patients admitted for catheter ablation (CA) of premature ventricular complexes (PVC) according to sex, and compared mapping strategy and procedural outcome in the two groups.

Clinical characteristics and outcomes from the CA procedures were retrospectively collected from health journals from patients undergoing CA for PVCs from 2011-2020 in our tertiary referral center.

We included 332 patients referred for CA of PVCs, of whom 208 (63%) were women. The women were younger than the men (46±14 vs 54±14 years, p<0.001), and fewer had coronary artery disease (1 vs 17%, p<0.001), hypertension (13 vs 23%, p=0.001), diabetes (1 vs 10%, p<0.001) and heart failure (2 vs 7%, p<0.001). In line with this, more women had a normal echocardiogram (79 vs 64%, p=0.004) and EF>50% (94 vs 85%, p=0.012). Despite less cardiac disease, more women were reported more symptoms in general (97 vs 87%, p<0.001), and palpitations specifically (80 vs 64%, p<0.001).

The women in our cohort had a numerically slightly lower PVC burden in the last 24h ECG prior to CA, although this did not reach statistical significance (17±12 vs 20±13%, p=0.110). More women than men had PVCs with origin in the outflow tracts (88 vs 79%, p=0.043). Woman and men did not differ with regard to acute success rate or complications. Activation mapping was less often used as the sole mapping strategy in women (52 vs 68%, p=0.012) but in a linear regression model that controlled for age, symptoms, number of PVCs and coupling interval, number of PVCs on last 24h ECG was the only parameter independently associated with mapping strategy (p=0.016).

In a subgroup analysis, we compared 154 women and 65 men without structural heart disease (no heart failure, coronary disease or valvular disease, and normal echocardiography with EF >50%). Even for this population, women were younger than men (46±13 vs 52±13 years, p=0.002). However, in these patients no statistical differences were found with regard to symptoms (97 vs 92%, p=0.080), outflow tract origin (89 vs 84%, p=0.4) or acute success rate (82 vs 78 %, p=0.6). Complications occurred in four patients (three pericardial effusions/tamponade and one unintended puncture of an artery), all in women (3 vs 0%, p=0.2).

The women admitted for CA of PVCs in our center were younger than the men, had a lower prevalence of structural heart disease, and more often outflow tract PVCs. For the subgroup without structural heart disease, no differences were found between the sexes, apart from referred women being younger. Acute outcomes and complications did not differ between the sexes in either analysis. Further studies are needed to clarify whether women develop idiopathic PVCs at a younger age than men, and the potential mechanism behind this phenomenon, or if they are referred to CA at an earlier time point of the disease.