Sex differences in atrial fibrillation treatment with catheter ablation in Southern Brazil: Real-world insights from a Latin American registry-SBR-AF.

Background: Sex differences in atrial fibrillation (AF) treatment remain unexplored in low- and middle-income settings. Women are less often referred for catheter ablation for AF, and whether procedural efficacy and safety differ by sex remains unclear in this population. Objective: The purpose of this study was to evaluate sex-based differences in baseline characteristics and clinical outcomes among patients with AF who underwent first-time radiofrequency catheter ablation in the Southern Brazilian Registry of Atrial Fibrillation (SBR-AF), a Latin American multicenter prospective registry with ≥12 months of follow-up. Methods: The primary end point was any atrial tachyarrhythmia recurrence. Safety outcomes included periprocedural complications through hospital discharge. Results: In our cohort of 1130 patients, 315 (27.9%) were women. Women were older, were more symptomatic, and had higher thromboembolic risk scores at the time of ablation. Paroxysmal AF was more common in women (82.2% vs 72.3%), whereas persistent AF predominated among men. Over a median follow-up of 1.4 years (interquartile range 1.0-3.6 years), atrial tachyarrhythmia recurrence occurred in 23.5% of women and 19.5% of men (log-rank, Conclusion: In the largest, real-world, multicenter, prospective cohort of AF ablation in Latin America, women underwent ablation at older ages with greater symptom burden yet achieved efficacy and safety comparable to men.