Sex Differences in Electrographic Flow Phenotypes and Outcomes in Patients Undergoing Pulmonary Vein Isolation

Sex Differences in Electrographic Flow Phenotypes and Outcomes in Patients Undergoing Pulmonary Vein Isolation
Ilana Kutinsky, MD; Steven Castellano, PhD; Nishaki Mehta, MD; Brian Williamson, MD; David Haines, MD; Melissa H. Kong, MD



Electrographic Flow (EGF) mapping allows for the near real-time visualization of atrial wavefront propagation. Two factors have been found to be associated with higher rates of AF recurrence: presence of active extra-pulmonary vein (PV) sources and low electrographic flow consistency (EGFC) representing chaotic flow and abnormal atrial substrate. Based on these characteristics, EGF phenotypes have been identified: Type I patients have no sources + high EGFC; Type II have sources + high EGFC; Type III have sources + low EGFC; Type IV have no sources + low EGFC.


Determine the sex differences in EGF phenotypes of AF and 1-year post-ablation outcomes.


Prospectively, 102 persistent or long-standing persistent AF (PeAF) patients underwent EGF mapping with 5 standardized, biatrial basket positions recorded both pre- and post-PVI. Phenotyping was performed from post-PVI maps. Patients were followed for 12 months post-randomization.


There were 29 (28%) female patients, mean age 70±8 years and mean LA size 4.3±0.5cm and 73 (72%) males, mean age 64±10 years and mean LA size 4.6±0.6cm. There was no difference in AF duration, history of atrial flutter, # of prior ablations, CHF, hypertension, diabetes, vascular disease. Male and female patients had distinct phenotype distributions (p<0.001). Females were more likely to have active extra-PV sources (72% v. 58%, p=0.011) and high EGFC (48% v. 35% with normal substrate, p=0.016) than males, and age was unrelated to source presence or EGFC (p>0.5). Females were over twice as likely to present as Type II (45% v. 21%, p<0.001). For the overall population, Type I patients had 0% recurrence and Type IV patients had 50% recurrence, while ablated Type II had 12% v. 50% unablated, and ablated Type III had 54% v. 73% unablated. 


Female patients with PeAF present for ablation at an older age and are more likely to have extra-PV sources but normal underlying substrate (Type II), which responds best to PVI + targeted source ablation.


A graph of different colored squaresDescription automatically generated with medium confidence
A) Phenotype distribution by sex;    B) Recurrence percent of treated patients.
<< Back to Scientific Program Table