Impact of sex on atrial structure, function, and atrial fibrillation recurrence following pulmonary vein isolation

Abstract Background Sex-related differences in atrial fibrillation (AF) presentation, cardiac structure, and treatment response have been increasingly recognized. While women are underrepresented in AF ablation trials, they often present with more advanced structural remodelling and symptomatic burden. However, whether these differences translate into distinct procedural outcomes and recurrence rates after pulmonary vein isolation (PVI) remains an area of active investigation. Purpose To compare baseline echocardiographic characteristics and long-term arrhythmia recurrence between female and male patients undergoing first-time AF catheter ablation. Methods This retrospective study included 72 consecutive patients (28 women, 44 men) who underwent first-time PVI between 2015 and 2024. Demographic, clinical, and echocardiographic data, including left atrial strain (LAS) parameters, were analysed. Arrhythmia recurrence was assessed at 1 and 3 years post-ablation using 12-lead ECG and Holter monitoring. Kaplan–Meier analysis and the log-rank test were used to evaluate recurrence-free survival. Results Women were significantly older than men (64.6 ± 7.2 vs. 58.5 ± 10.4 years, p