Abstract
Many important differences in the presentation and clinical course of cardiac arrhythmias are present between men and women that should be accounted for in clinical practice. In this paper, we review published data on gender differences in cardiac excitable properties, supraventricular tachycardias, ventricular tachycardias, sudden cardiac death, and the utilisation of implantable defibrillators and cardiac resynchronisation therapy. Women have a higher heart rate at rest, and a longer QT interval than men. They further have a narrower QRS complex and lower QRS voltages on the 12-lead ECG with more often non-specific repolarisation abnormalities at rest. Supraventricular tachycardias, such as AV nodal reentrant tachycardia, are twice as frequent in women compared with men. Atrial fibrillation, however, has a 1.5-fold higher prevalence in men. The triggers for idiopathic right ventricular outflow tract tachycardia (VT) initiation are gender specific, i.e. hormonal changes play an important role in the occurrence of these VTs in women. There are clear-cut gender differences in acquired and congenital LQTS. Brugada syndrome affects men more commonly and severely than women. Sudden cardiac death is less prevalent in women at all ages and occurs 10 years later in women than in men. This may be related to the later onset of clinically manifest coronary heart disease in women. Among patients who receive ICDs and CRT devices, women appear to be under-represented, while they may benefit even more from these novel therapies.
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References
Bazett HC. An analysis of the time-relations of electrocardiogram. Heart. 1920;7:353–70.
Liu K, Ballew C, Jacobs Jr DR, Sidney S, Savage PJ, Dyer A, et al. Ethnic differences in blood pressure, pulse rate, and related characteristics in young adults. The CARDIA study. Hypertension. 1989;14:218–26.
Larsen JA, Kadish AH. Effects of gender on cardiac arrhythmia. J Cardiovasc Electrophysiol. 1998;9:655–64.
Bernal O, Moro C. Cardiac arrhythmias in women. Rev Esp Cardiol. 2006;59:609–18.
Josephson ME, Kastor JA. Supraventricular tachycardia: mechanisms and management. Ann Intern Med. 1977;87:346–58.
Insulander P, Kenneback G, Straat E. Differences in dual AV nodal properties between men and women. Eur Heart J. 1999;20:568. abstract.
Yarnoz MJ, Curtis AB. More reasons why men and women are not the same (gender differences in electrophysiology and arrhythmias). Am J Cardiol. 2008;101:1291–6.
Dagres N, Nieuwlaat R, Vardas PE, Andresen D, Lévy S, Cobbe S, et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol. 2007;49:572–7.
Essebag V, Reynolds MR, Hadjis T, Lemery R, Olshansky B, Buxton AE, et al. Sex differences in the relationship between amiodarone use and the need for permanent pacing in patients with atrial fibrillation. Arch Intern Med. 2007;167:1648–53.
Burke JH, Ehlert FA, Kruse JT, Parker MA, Goldberger JJ, Kadish AH. Gender-specific differences in the QT interval and the effect of autonomic tone and menstrual cycle in healthy adults. Am J Cardiol. 1997;79:178–81.
Elkayam M, Goodwin TM. Adenosine therapy for supraventricular tachycardia during pregnancy. Am J Cardiol. 1995;75:521–3.
Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular tachycardia. J Am Coll Cardiol. 2003;42:1493–531.
Nakagawa M, Katou S, Ichinose M, Nobe S, Yonemochi H, Miyakawa I, et al. Characteristics of new-onset ventricular arrhythmias in pregnancy. J Electrocardiol. 2004;37:47–53.
Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers for right ventricular outflow tract tachycardia. Am Heart J. 2000;139:1009–13.
Rivero A, Curtis AB. Sex differences in arrhythmias. Curr Opin Cardiol. 2010;25:8–15.
Sacher F, Meregalli P, Veltmann C, Field ME, Solnon A, Bru P, et al. Are women with severely symptomatic brugada syndrome different from men? J Cardiovasc Electrophysiol. 2008;19:1181–5.
Jongman JK, Jepkes-Bruin N, Ramdat Misier AR, Beukema WP, Delnoy PP, Oude Lutttikhuis H, et al. Electrical storms in Brugada syndrome successfully treated with isoproterenol infusion and quinidine orally. Neth Heart J. 2007;15:151–5.
Solomon SD, Zelenkofske S, McMurray JJ, Finn PV, Velazquez E, Ertl G, et al. Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure or both. N Engl J Med. 2005;352:2581–8.
Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States 1989 to1998. Circulation. 2001;104:2158–63.
Chugh SS, Uy-Evanado A, Teodorescu C, Reinier K, Mariani R, Gunson K, et al. Women have a lower prevalence of structural heart disease as a precursor to sudden cardiac arrest: the Ore-SUDS (Oregon Sudden Unexpected Death Study). J Am Coll Cardiol. 2009;54:2006–11.
Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global use of strategies to open occluded coronary arteries in acute coronary syndromes IIb investigators. N Engl J Med. 1999;341:226–32.
Freedman RA, Swerdlow CD, Soderholm-Difatte V, Mason JW. Clinical predictors of arrhythmia inducibility in survivors of cardiac arrest: importance of gender and prior myocardial infarction. J Am Coll Cardiol. 1988;12:973–8.
Buxton AE, Hafley GE, Lehmann MH, Gold M, O’Toole M, Tang A, et al. Prediction of sustained ventricular tachycardia inducible by programmed stimulation in patients with coronary artery disease. Utility of clinical variables. Circulation. 1999;99:1843–50.
Davis DR, Tang AS, Lemery R, Green MS, Gollob MH, Birnie DH. Influence of gender on ICD implantation for primary and secondary prevention of sudden cardiac death. Europace. 2006;8:1054–6.
Russo AM, Day JD, Stolen K, Mullin CM, Doraiswamy V, Lerew DL, et al. Implantable cardioverter defibrillators: do women fare worse than men? Gender comparison in the INTRINSIC RV trial. J Cardiovasc Electrophysiol. 2009;20:973–8.
Chen HA, Hsia HH, Vagelos R, Fowler M, Wang P, Al-Ahmad A. The effect of gender on mortality or appropriate shock in patients with nonischemic cardiomyopathy who have implantable cardioverter-defibrillators. Pacing Clin Electrophysiol. 2007;30:390–4.
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter automatic defibrillator implantation trial investigators. N Engl J Med. 1996;335:1933–40.
Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. MIRACLE Study Group. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346:1845–53.
Stellbrink C, Breithardt OA, Franke A, Sack S, Bakker P, Auricchio A, et al. PATCH-CHF investigators. Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conducton disturbances. J Am Coll Cardiol. 2001;38:1957–65.
Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. Multisite Stimulation in Cardiomyopathies (MUSTIC) study investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344:873–80.
Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. MADIT-CRT trial investigators. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361:1329–38.
Woo GW, Petersen-Stejskal S, Johnson JW, Conti JB, Aranda Jr JA, Curtis AB. Ventricular reverse remodeling and 6-months outcomes in patients receiving cardiac resynchronization therapy: analysis of MIRACLE study. J Interv Card Electrophysiol. 2005;12:107–13.
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140–50.
Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–49.
Zardkoohi O, Nandigam V, Murray L, Heist EK, Mela T, Orencole M, et al. The impact of age and gender on cardiac resynchronization therapy outcome. Pacing Clin Electrophysiol. 2007;30:1344–8.
Bleeker GB, Schalij MJ, Boersma E, Steendijk P, van der Wall EE, Bax JJ. Does a gender difference in response to cardiac resynchronization therapy exist? Pacing Clin Electrophysiol. 2005;28:1271–5.
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Ghani, A., Maas, A.H.E.M., Delnoy, P.P.H.M. et al. Sex-Based Differences in Cardiac Arrhythmias, ICD Utilisation and Cardiac Resynchronisation Therapy. Neth Heart J 19, 35–40 (2011). https://doi.org/10.1007/s12471-010-0050-8
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DOI: https://doi.org/10.1007/s12471-010-0050-8