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of AF Ablation in Women\nMultiple studies have found that women are more symptomatic from AF, have a lower QOL, and are less tolerant of AADs than men.806,1046,1047,1048,1049 However, the rate of referral of women for catheter ablation of AF is significantly lower than men, and women are referred much later after failing more AADs.920 There has not been consistent evidence to support female sex as a predictor of recurrence after AF ablation, based on multiple univariate and multivariate analyses.252,1050,1051 A systematic review of predictors of AF recurrence after catheter ablation reported that none of the 23 studies found female sex to be a predictor of recurrence.1050\nAt least four major studies have specifically examined outcomes after ablation of AF in women. A large, retrospective multicenter study involved 3265 consecutive patients with drug-refractory AF who underwent PVI.289,290,291 Women constituted a much lower percentage of the patients referred for ablation, were referred later for ablation, had failed more AADs, more often had hypertension, and were older at the time of the procedure. After 24 ± 16 months of follow-up, the women had significantly lower success rates than the men, defined as single-procedure freedom from recurrent AF off AADs (68.5 vs 77.5%; P \u003c.001). Another study also found a lower success rate in women after a single catheter ablation procedure (35.6% in women vs 57.1% in men; P = .003); however, once repeat procedures were taken into account, there was no significant difference in outcome.1052\nOther studies have not shown a difference in outcomes between men and women.1053,1054 Most recently, a large-scale prospective analysis of sex-related differences in catheter ablation of AF that enrolled 1124 patients with PAF was reported from Japan.1054 After a mean follow-up of 31.7 ± 24.4 months following the index ablation, there was no significant difference in success rates or complication rates between women and men.\nSex-related recurrence rates have been reported as nonprimary end points in at least 17 other studies, most of which did not reveal significant sex-related differences.1055\nFemale sex has been reported as a predictor of complications after AF ablation, and higher complication rates from AF ablation in women have repeatedly been found.252,289,290,291,806,808,920,1050,1051,1052,1053,1054,1056,1057,1058,1059 A multicenter U.S. retrospective study reported total complications of 3265 (518 in women vs 2747 in men), with a 5% complication rate in women vs 2.4% in men (P \u003c.001). This study found more hematomas and pseudoaneurysms in women.289,290,291 A large multicenter registry from Italy that enrolled 2323 patients also reported a significantly higher complication rate in women (7% vs 4.4%), and female sex was reported to be an independent predictor of a higher risk of complications by univariate analysis (OR 2.643; 95% CI 1.686–4.143; P \u003c.0001).1059\nOverall, studies have not shown a significant sex-related difference in outcomes with AF ablation in women compared with men, but complication rates are consistently higher in women."}