Sex-based disparities in postoperative outcomes after catheter ablation for atrial fibrillation: a systematic review and meta-analysis of propensity-matched studies

BACKGROUND AND AIM: Sex-related differences in outcomes after catheter ablation for atrial fibrillation (AF) remain incompletely understood, particularly regarding long-term arrhythmia recurrence and procedural safety. Current guidelines do not provide sex-specific recommendations. This systematic review and meta-analysis aimed to evaluate sex-based differences in efficacy, safety, and long-term outcomes following AF catheter ablation. METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines and the Cochrane Handbook, with prospective registration in PROSPERO (CRD420251168422). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2025. Only studies adjusting for baseline differences using propensity score-based methods were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a restricted maximum likelihood random-effects model. Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated using GRADE. RESULTS: = 0%, τ²=0, p = 0.0020). CONCLUSION: Catheter ablation yields similar short-term rhythm control and mortality in women and men with AF. However, women have higher early procedural complications and worse long-term outcomes, including increased 2-year AF/AT recurrence and heart failure, highlighting the need for tailored strategies and closer follow-up in female patients.