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ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1556222
Female sex is an independent risk factor for recurrence after Ethanol Marshall bundle elimination in atrial fibrillation ablation
Provisionally accepted
Hongxu Chen 1,2*
XIONG XIONG 2
Dan Chen 2 Xi Li 3 Liheng Yang 2 Zuowei Liu 1,2
Yanhong Chen 2*
Jinlin Zhang 2*- 1 Wuhan University of Science and Technology, Wuhan, China
- 2 Wuhan Asia Heart Hospital, Wuhan, Hubei Province, China
- 3 Wuhan Asia General Hospital, Wuhan, Hebei Province, China
Background: Atrial fibrillation (AF) exhibits gender disparities in prevalence, complications, pharmacological management, and ablation efficacy. Ethanol infusion of vein of Marshall (EIVOM) is promising for enhancing AF ablation success rate, yet sex differences of EIVOM are lacking evidence. Method: This was a non-randomized, single-center, retrospective observational study. AF patients received stepwise ablations composed of EIVOM, pulmonary vein isolation (PVI) and linear ablation. The primary endpoint was defined as recurrence of atrial tachycardia over 30 seconds. Propensity score matching (PSM) was performed to reduce selection bias. Results: From April 2020 to May 2022, 432 patients were included, comprising of 288 male patients and 144 female patients. Compared with male, female patients were older, with worse heart function class. EIVOM success rate was significantly lower in female patients compared with male patients (86.1% vs 93.4%). No significant differences in major procedural complications were observed between male and female patients. During a median follow-up of 12 months, female patients had significantly higher AF recurrence. Multi-variate Cox regression analysis showed that female sex, BMI<21.62, LAD>47mm, and CAFEs ablation are independent risk factors of AF recurrences. After propensity score matching (PSM), AF recurrence rate remained statistically higher in female patients compared with male patients. Conclusion: Compared with males, female patients are older, more symptomatic, with worse heart function. Female patients had significantly higher AF recurrence after EIVOM combing catheter ablations.
Keywords: Atrial Fibrillation, Catheter Ablation, Vein of Marshall, sex differences, female
Received: 06 Jan 2025; Accepted: 31 Mar 2025.
Copyright: © 2025 Chen, XIONG, Chen, Li, Yang, Liu, Chen and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongxu Chen, Wuhan University of Science and Technology, Wuhan, China
Yanhong Chen, Wuhan Asia Heart Hospital, Wuhan, 430000, Hubei Province, China
Jinlin Zhang, Wuhan Asia Heart Hospital, Wuhan, 430000, Hubei Province, China
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