Arrhythmias and conduction disturbance
More Reasons Why Men and Women Are Not the Same (Gender Differences in Electrophysiology and Arrhythmias)

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It has become increasingly apparent in recent years that there are important differences in the presentation and clinical course of many cardiovascular disorders in men and women. These gender differences extend to clinical cardiac electrophysiology, with respect to basic electrophysiology as well as the presentation and clinical courses of many arrhythmias. Women have been noted to have higher heart rates at rest and longer corrected QT intervals compared with men. Differences in gender hormones may explain some of these findings, but precisely how is still not well understood. Differences have also been documented in the incidence and prevalence of specific arrhythmias, including atrial fibrillation, other supraventricular tachycardias, and sudden cardiac death. Variations in arrhythmia frequency with respect to the menstrual cycle have been observed. In addition, an increase in arrhythmia frequency or the new onset of arrhythmias has been noted during pregnancy. With the increasing use of implantable cardioverter defibrillators and cardiac resynchronization therapy, it has been shown that men and women derive equal survival and symptom reduction benefit. However, it has been found that the use of these devices in women is much lower than would be expected from the prevalence of disease in the population. The reasons for this lower utilization rate are not well understood and remain to be explored. In conclusion, the goal of this review is to summarize the currently available published reports regarding gender differences in cardiac electrophysiology and arrhythmias and to provide an update from recent studies.

Section snippets

Gender Differences in Electrocardiography and Cardiac Electrophysiology

A number of differences in cardiac electrophysiology have been identified by various investigators. These differences almost certainly play a role in the prevalence of different arrhythmias seen clinically, although the mechanisms by which differences in electrophysiology translate into arrhythmia behavior are not well understood. It was shown as early as 1920 by Bazett1 that women have higher heart rates at rest than men. In a large population from the Coronary Artery Risk Development in Young

Supraventricular tachycardia (SVT)

There are clear-cut differences between men and women in the prevalence and clinical courses of various SVTs. Rodriguez et al10 summarized these differences (Table 1), which have been confirmed in subsequent studies of large numbers of patients. For example, atrioventricular nodal reentrant tachycardia has a 2:1 women-to-men predominance. In contrast, atrioventricular reentrant tachycardia in patients with accessory pathways, including Wolf-Parkinson-White syndrome, is observed twice as often

Sudden Cardiac Death

In the United States, SCD is estimated to account for 300,000 to 400,000 deaths per year. Epidemiologic studies evaluating out-of-hospital cardiac arrests demonstrate that women present more commonly with asystole and pulseless electrical activity, whereas men usually have ventricular tachycardia and ventricular fibrillation.31 Multiple studies have evaluated the clinical characteristics and presentation of SCD in women compared with men. An analysis of the Framingham population revealed that

Pregnancy

Pregnancy and the postpartum period are special situations that appear to convey additional arrhythmic risk. During this period, there is an increased risk for SVT. Tawam et al40 retrospectively analyzed 60 consecutive women presenting with SVT, finding an increased risk for new-onset SVT and exacerbations during pregnancy (relative risk 5.1, p <0.001). Symptoms of SVT were also increased. The mechanisms for an increase in SVT are speculated to include hormones, autonomic tone, and increased

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