MANIFEST-PF analysis shows no gender difference in PFA outcomes


Women with atrial fibrillation (AF) undergoing pulsed field ablation (PFA) have just as good outcomes as men according to a large-scale international study published in JAMA Cardiology.

This study is the first to compare sex outcomes for AF patients undergoing PFA, and show that the procedure is safe and just as effective for men as for women.

“These results are important, as women are underrepresented in prior ablation studies and the results have been mixed with regards to both safety and effectiveness using conventional ablation strategies such as radiofrequency or cryoablation,” says first author Mohit Turagam, (Icahn Mount Sinai, New York, USA).

The researchers did a retrospective analysis of 1,568 patients from the MANIFEST-PF registry, taking in data from 24 European centres and includes patients who underwent their first-ever PFA for AF between March 2021 and May 2022.

The researchers categorised patients by sex and evaluated clinical outcomes of PFA within these groups. They studied the elimination of AF, and adverse events such as oesophageal complications, pulmonary vein stenosis, phrenic nerve injury, pericardial tamponade (fluid accumulation in the heart), and vascular injury.

The results showed no significant difference in recurring atrial arrhythmia in men versus women. Specifically, 79% of men versus 76% of women did not have recurring atrial arrhythmia after PFA, a difference that was not statically significant. The rate of patients needing a second ablation were similar between sexes, with men at 8.3% versus women at 10%, also not statically significant.

Among the patients who underwent a second AF ablation, pulmonary vein isolation durability was significantly higher in women than in men (63% versus 37.8%), meaning they were less likely to have an additional ablation in their pulmonary veins. Complication rates from the procedure were low overall, and did not differ significantly by sex (women at 2.5% versus men at 1.5%).

“For the last few years, the emerging data with pulsed field energy has been quite promising for the treatment of AF. This current analysis of the large-scale MANIFEST-PF registry demonstrates that the benefits are not just limited to men; women derive the same level of success at one year, 76.3%, with a low complication rate of 2.5%. Thus, women should not be denied the beneficial, life-enhancing procedure of catheter ablation for atrial fibrillation,” says senior author Vivek Reddy (Icahn Mount Sinai, New York, USA).


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