Sex-Based Differences in Clinical Outcomes of Pulmonary Vein Isolation Versus Antiarrhythmic Drug Therapy as First-Line Treatment For Atrial Fibrillation

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Pulmonary vein isolation (PVI) is superior to antiarrhythmic drug (AAD) as first-line treatment for certain atrial fibrillation (AF). However, limited data exist on whether these benefits differ between sexes. METHODS We used TriNetX to identify adults with AF who received either PVI or AAD as first-line therapy. Outcomes were assessed separately in men and women receiving PVI vs. AAD, followed by a direct comparison of men and women undergoing PVI as first-line therapy. Five-year outcomes were all-cause death, all-cause hospitalization, heart failure (HF) hospitalization, ischemic stroke, and major bleeding (intracranial or gastrointestinal). RESULTS A total of 181,840 men and 145,385 women were included. Women were less likely than men to undergo PVI as first-line therapy (0.6% vs. 1.0%, P< 0.01). After propensity score matching, PVI was associated with lower risks of all-cause death and all-cause hospitalization than AAD in both sexes. PVI was associated with a reduced risk of HF exacerbation in men but not in women. No significant differences were observed in ischemic stroke or major bleeding in both sexes. Direct comparison of men and women undergoing PVI as first-line therapy showed no differences in all clinical outcomes assessed. CONCLUSION Women were less likely to undergo PVI as first-line therapy; however, PVI reduced all-cause mortality and hospitalization in both sexes. Additionally, a benefit in reducing HF exacerbations was observed in men but not in women.

Volume

87

Issue

13 Suppl

First Page

A113

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A113

DOI

10.1016/j.jacc.2026.02.285

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