Impact of operator-patient sex concordance on patient outcomes in cardiac electrophysiology procedures for atrial fibrillation

Background — Data are conflicting on whether operator-patient sex concordance has an impact on patient outcomes. This paper aims to describe the sex distribution in electrophysiology operators in Ontario, Canada and elucidate the association between patient outcomes and operator-patient sex concordance.

Methods — This population-based retrospective cohort study included patients with atrial fibrillation who were referred for catheter ablation in Ontario between April 1, 2011 and March 31, 2023. Operator-patient sex concordance was defined as the patient and operator having the same sex. The primary outcome was the difference in adverse outcomes post-ablation procedure through a composite of death, stroke, hospitalization, and emergency department visits, with follow-up until March 31, 2024.

Results — A total of 13,711 patients had a cardiac ablation procedure done between April 2011 and March 2023; of these, only 143 were done by female operators (< 1%). A total of 67 operators performed procedures over this period, with ≤ 5 being female. Female patients had worse adjusted outcomes compared to male patients, with a hazard ratio (HR) of 1.29 (95% confidence interval [CI] 1.22-1.37). No significant difference was present in outcomes for patients of female vs male operators (HR 0.81; 95% CI 0.60-1.10). Female patients with a female operator had outcomes comparable to those of female patients with a male operator (HR 0.93; 95% CI 0.58-1.50). Similar findings were seen for male patients with female vs male operators (HR 0.74; 95% CI 0.50-1.10).

Conclusions — Our data suggest that no significant associations are present between the sex concordance of patients and operators and cardiac ablation outcomes, though female operators were substantially underrepresented.