Dąbrowski, Emil J

Kowalewski, Mariusz

Kurasz, Anna

Kuźma, Łukasz

Via Medica Journals

w w w . j o u r n a l s . v i a m e d i c a . p l / p o l i s h _ h e a r t _ j o u r n a l918Correspondence to:Mariusz Kowalewski MD, PhD,Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute  of the Ministry of Interior  and Administration, Wołoska 137, 02–507 Warszawa, Poland,phone: +48 502 269 249,e-mail: kowalewskimariusz@gazeta.plCopyright by the Author(s), 2024DOI: 10.33963/v.phj.101415Received:  July 1, 2024Accepted:  July 1, 2024Early publication date:  July 2, 2024  L E T T E R  T O  T H E  E D I T O RPreoperative atrial fibrillation in patients undergoing cardiac surgery: Gender versus other factors. Authors’ replyAnna Kurasz1, Emil J Dąbrowski1, Mariusz Kowalewski2–4, Łukasz Kuźma11Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland2Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warszawa, Poland3Thoracic Research Center, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland4Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC), Cardiovascular Research Centre Maastricht (CARIM), Maastricht, the NetherlandsWe greatly appreciate the comments on our recent publication investigating sex differ-ences in long-term survival following cardiac surgery in patients with pre-operative atrial fibrillation (AF) [1] by Drs Engin and Yavuz [2]. Certainly, the duration of pre-operative AF and type of performed cardiac surgery might affect prognosis. However, one of the previously listed limitations of the KROK Registry is lack of data on the exact type of AF and detailed information on the conversion to sinus rhythm during follow-up [3].We note that there were numerically higher rates of surgical ablation (SA) in wom-en (15.2% vs. 13.3%; P = 0.056) in our cohort, and the fact that the evidence regarding sex-related differences in patients undergoing SA is limited. Shah et al. [4] found that women undergoing surgical correction of AF are older and more frequently suffer from heart failure, although there were no differences in survival after adjustments. According to previous re-search investigating disparities between men and women undergoing catheter ablation, women undergoing ablation are older, are more likely to have paroxysmal AF, and are at greater risk of peri-procedural complications and recurrence of arrhythmia, with no differ-ence in all-cause mortality [5, 6]. In order to investigate this topic thor-oughly in the registry, we have now con-ducted further analyses focusing on patients undergoing SA (n = 696; 41% undergoing concomitant coronary artery bypass grafting). Visual inspection shows a worse prognosis in women, which is limited only to the first year after the procedure with curves crossover and no significant differences in survival during the overall follow-up time (log-rank P = 0.1). In Cox’s proportional hazard regression, there were no significant differences during 90-day follow up (hazard ratio [HR] 1.48; 95% confidence interval [CI], 0.78–2.8; P = 0.23), or at one year (HR 0.92; 95% CI, 0.58–1.48; P = 0.74), or at two years (HR 0.81; 95% CI, 0.53–1.26; P = 0.36). Our results indicate that SA might influence differences between men and women in long- -term survival. However, due to the relatively small analyzed group, the findings should be considered only as hypothesis-generating, and should guide further research that in-cludes subgroup investigations, especially based on the pre-operative AF type and the post-procedural conversion to sinus rhythm.The potential sources of disparities in sur-vival between men and women are certainly multi-factorial. Firstly, men have significantly higher rates of most major comorbidities and are more frequently referred for urgent procedures. The higher rates of urgent surgery might have influenced the lower rates of both SA and left atrial appendage occlusion in men, as these procedures often require pro-longation of cardio-pulmonary bypass time. We noted a remarkable increase in the rates of left atrial appendage occlusion reported in the KROK Registry during the observation, w w w . j o u r n a l s . v i a m e d i c a . p l / p o l i s h _ h e a r t _ j o u r n a l 919Łukasz Pyka, et al., Zero-contrast TAVIreaching 22.9% in the last full year. In our study, women had higher rates of post-operative complications, which has also been reported previously and may be related to anatomical and hormonal differences, and may sub-sequently result in impaired short-term survival. Women may also benefit from better compliance with healthcare professionals’ advice, and more adoption of long-term life-style modifications and of disease control strategies such as rehabilitation, mitigation of risk factors and secondary prevention, which may be reflected in the curves crossover two years after the index procedure. Finally, the impact of exposome should not be underestimated, as it has been shown that the influence of environmental factors differs between men and women [7].Article information Conflict of interest: None declared. Funding: None. Open access: This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 Interna-tional (CC BY-NC-ND 4.0) license, which allows downloading and sharing articles with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. For commercial use, please contact the journal office at polishheartjournal@ptkardio.plREFERENCES1. Kuźma Ł, Kowalewski M, Gostomczyk K, et al. Long-term survival after cardiac surgery in male and female patients with underlying atrial fibril-lation. Pol Heart J. 2024; 82(7–8): 783–786, doi: 10.33963/v.phj.100976, indexed in Pubmed: 38845430.2. Engin M, Yavuz S. Preoperative atrial fibrillation in patients undergoing cardiac surgery: Gender versus other factors. Pol Heart J. 2024; 82(7–8): 818–819, doi: 10.33963/v.phj.101227, indexed in Pubmed: 38973444.3. Kowalewski M, Dąbrowski EJ, Kuźma Ł, et al. Tricuspid intervention for less-than-severe regurgitation simultaneously with minimally invasive mitral valve surgery in patients with atrial fibrillation. Kardiol Pol. 2023; 81(10): 990–997, doi: 10.33963/KP.a2023.0137, indexed in Pubmed: 37366255.4. Shah SV, Kruse J, Andrei AC, et al. Gender differences in outcomes after surgical ablation of atrial fibrillation. J Thorac Cardiovasc Surg. 2016; 151(2): 391–3988.e2, doi: 10.1016/j.jtcvs.2015.09.062, indexed in Pubmed: 26507404.5. Yunus FN, Perino AC, Holmes DN, et al. Sex differences in ablation strategy, lesion sets, and complications of catheter ablation for atrial fibrillation: An analysis from the GWTG-AFIB registry. Circ Arrhythm Electrophysiol. 2021; 14(11): e009790, doi:  10.1161/CIRCEP.121.009790, indexed in Pubmed: 34719235.6. Cheng X, Hu Q, Gao L, et al. Sex-related differences in catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Europace. 2019; 21(10): 1509–1518, doi:  10.1093/europace/euz179, indexed in Pubmed: 31281922.7. Kuźma Ł, Dąbrowski EJ, Kurasz A, et al. Effect of air pollution exposure on risk of acute coronary syndromes in Poland: A nationwide popula-tion-based study (EP-PARTICLES study). Lancet Reg Health Eur. 2024; 41: 100910, doi:  10.1016/j.lanepe.2024.100910, indexed in Pubmed: 38665621.

Preoperative atrial fibrillation in patients undergoing cardiac surgery: Gender versus other factors. Authors’ reply

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Preoperative atrial fibrillation in patients undergoing cardiac surgery: Gender versus other factors. Authors’ reply

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