Sex-Based Differences in Symptomatology in the First Month Following Atrial Fibrillation Catheter Ablation.

Background: Differences in baseline characteristics and clinical outcomes exist between female and male patients with atrial fibrillation (AF).

Objective: To assess sex-specific symptoms within 1 month of AF catheter ablation.

Methods: Patients undergoing AF ablation between 2000 and 2024 were identified from 57 healthcare organizations using a global federated research network. Female and male patients were 1:1 propensity score matched (PSM) based on baseline characteristics. Symptoms within a month of ablation were identified using ICD-10 codes and classified into major systems: cardiac (chest pain, palpitations), respiratory (dyspnea, cough), gastrointestinal (nausea, vomiting, heartburn, dysphagia, bloating, diarrhea, constipation, anorexia), neurological (headache, visual disturbance, speech disturbance, dizziness) and urological (urinary retention and dysuria).

Results: After PSM, 69 244 patients were included (34 622 in each group). Female patients had a higher incidence of cardiac (female, 8.9% vs. male, 6.1%; p < 0.001), respiratory (7.9% vs. 6.1%; p < 0.001), gastrointestinal (3.4% vs. 2.2%; p < 0.001) and neurological symptoms (3.1% vs. 2.5%; p < 0.001) compared with male patients. Urological symptoms were more common in male patients (1.6% vs. 0.9%; p < 0.001) due to a higher incidence of urinary retention (1.1% vs. 0.3%; p < 0.001). All individual symptom components of cardiac, respiratory, gastrointestinal and neurological composites were more common in female patients, except from heartburn (0.1% vs. 0.1%; p = 0.49), bloating (0.2% vs. 0.2%; p > 0.99), anorexia (0.1% vs. 0.1%; p = 0.79), and speech disturbance (0.2% vs. 0.2%; p = 0.51) which were similar between sexes.

Conclusion: Compared with male patients, female patients experience higher rates of cardiac, respiratory, gastrointestinal, and neurological symptoms within 1 month of AF ablation.