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Arrhythmia in Cardiomyopathy: Sex and Gender Differences

  • Sex and Gender Aspects in Heart failure (G. Figtree and C. Arnott, Section Editors)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

There is emerging evidence for important sex differences in cardiac arrhythmias. In this up-to-date review, we summarise the differences in incidence, aetiology, treatment and prevention of ventricular arrhythmias (VAs) and sudden cardiac death (SCD) in women versus men, in the context of ischaemic and nonischaemic cardiomyopathies.

Recent Findings

The incidence of ventricular tachyarrhythmia and SCD is significantly lower in women than in men with ischaemic cardiomyopathy, whereas sex differences in nonischaemic cardiomyopathy are less clear. Women who receive a primary prevention implantable cardioverter-defibrillator (ICD) are less likely to receive appropriate activations, compared to men; however, such findings are limited by under-representation of women.

Summary

Women with ischaemic cardiomyopathy have significantly lower incidence of VA and SCD compared to men and may not derive the same benefit from a primary prevention ICD. However, further clinical ICD studies are needed that ensure adequate female participation, in order to examine sex differences in outcomes in both ischaemic and nonischaemic cardiomyopathies.

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Abbreviations

AAD:

Antiarrhythmic drug

APD:

Action potential duration

CA:

Catheter ablation

CAD:

Coronary artery disease

CI:

Confidence interval

CRT-D:

Cardiac resynchronisation therapy with an implantable cardioverter-defibrillator

EP:

Electrophysiology

EPS:

Electrophysiology study

HF:

Heart failure

HR:

Hazard ratio

ICD:

Implantable cardioverter-defibrillator

ICM:

Ischaemic cardiomyopathy

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

NICM:

Nonischaemic cardiomyopathy

NYHA:

New York Heart Association

OMT:

Optimal medical therapy

PVC:

Premature ventricular complex

SCD:

Sudden cardiac death

TdP:

Torsades de Pointes

VA:

Ventricular tachyarrhythmia

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

WCD:

Wearable cardioverter-defibrillator

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Authors and Affiliations

  1. Department of Cardiology, Westmead Hospital, Sydney, Australia

    Sul Ki Kim, Richard Bennett, Saurabh Kumar & Sarah Zaman

  2. Westmead Applied Research Centre, The University of Sydney, Sydney, Australia

    Richard Bennett, Saurabh Kumar & Sarah Zaman

  3. Cardio Genomics Program At Centenary Institute, The University of Sydney, Sydney, Australia

    Jodie Ingles

  4. Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

    Jodie Ingles

  5. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia

    Jodie Ingles

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  1. Sul Ki Kim
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Correspondence to Sarah Zaman.

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Kim, S.K., Bennett, R., Ingles, J. et al. Arrhythmia in Cardiomyopathy: Sex and Gender Differences. Curr Heart Fail Rep 18, 274–283 (2021). https://doi.org/10.1007/s11897-021-00531-0

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