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Arritmias cardiacas en la mujerCardiac Arrhythmias in Women

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El objetivo de esta revisión fue analizar las diferencias electrofisiológicas entre sexos ya descritas, así como la presentación y el tratamiento clínico de las arritmias en las mujeres.

La evidencia, según los datos de los estudios publicados hasta el momento, nos muestra que las mujeres tienen una frecuencia cardiaca media superior, un intervalo QT más largo, una menor duración del complejo QRS, así como un menor voltaje de éste respecto a los varones. Asimismo, en las mujeres son más frecuentes la enfermedad del nódulo sinusal, la taquicardia sinusal inapropiada, la taquicardia supraventricular intranodal, la taquicardia ventricular idiopática del ventrículo derecho, y el síndrome QT largo congénito y adquirido; en cambio, en los varones, la prevalencia de las siguientes arritmias es mayor: bloqueo auriculoventricular, hipersensibilidad del seno carotídeo, fibrilación auricular, taquicardia supraventricular con vía accesoria, síndrome de Wolff-Parkinson-White, taquicardia ventricular por reentrada, fibrilación ventricular y muerte súbita, así como el síndrome de Brugada.

Con respecto a los dispositivos, se observó que tanto los varones como las mujeres obtienen un beneficio similar con el marcapasos y el desfibrilador, y tampoco hubo diferencias en el porcentaje de buena respuesta a la resincronización entre ambos sexos, con una supervivencia similar; sin embargo, llama la atención la escasa participación femenina en los estudios de investigación de todas las técnicas terapéuticas, tanto la ablación como la resincronización y el desfibrilador automático implantable.

The aim of this study was to review published data on gender differences in cardiac electrophysiology and in the presentation and clinical treatment of arrhythmias.

The evidence from studies published to date show that women have a higher mean resting heart rate, a longer QT interval, a shorter QRS duration, and a lower QRS voltage than men. Women have a higher prevalence of sick sinus syndrome, inappropriate sinus tachycardia, atrioventricular nodal reentry tachycardia, idiopathic right ventricular tachycardia, and arrhythmic events in the long- QT syndrome. In contrast, men have a higher prevalence of atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia due to accessory pathways, Wolff-Parkinson-White syndrome, reentrant ventricular tachycardia, ventricular fibrillation and sudden death, and the Brugada syndrome.

With regard to implantable devices, it has been reported that defibrillators offer similar benefits in men and women. Moreover, there is no gender difference in the percentage who respond well to resynchronization therapy: survival is similar in the two sexes. However, it should be noted that few women have participated in studies of all types of therapy, including catheter ablation, resynchronization therapy, and the use of implantable defibrillators.

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