Abstract
BACKGROUND: Sex-specific differences in the clinical outcome of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remain controversial. The impact of body mass index (BMI) on sex-based variation in the outcome of PVI is not well understood. OBJECTIVE: We sought to investigate the impact of BMI with associated atrial conduction indices (ACIs) on sex-specific differences in AF recurrence after PVI. METHODS: All consecutive patients who underwent their first PVI for AF from 2014 to 2019 were included. ACIs were measured on the surface electrocardiogram and intracardiac electrogram. Data were collected and analyzed based on BMI and sex. RESULTS: The study included 387 patients with AF (121 women and 266 men; mean age 66 years; 49.2% with a BMI of ≥30 kg/m(2)). Women were older at the time of the procedure (median age 67 vs 62 years; P < .001). AF recurrence was more common in women (57% vs 44.4%) during a mean 5 ± 3 years' follow-up (P = .027). All-cause mortality was similar in men and women after PVI, irrespective of AF recurrence (P > .05). Post-PVI atrial flutter (AFL) occurred more often in women (21.5% vs 10.9%; P = .009). Female sex, enlarged left atria, prolonged ACI, and post-PVI AFL were predictors of AF recurrence (P < .05). High BMI and prolonged left ACI were associated with AF recurrence in women. CONCLUSION: Female sex was associated with a higher risk of AF recurrence after PVI and post-PVI AFL. Women with high BMI and prolonged left ACI had the highest rate of AF recurrence. This highlights the importance of weight management.