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Gepubliceerd in: Netherlands Heart Journal 1/2011

01-01-2011 | Review Article

Sex-Based Differences in Cardiac Arrhythmias, ICD Utilisation and Cardiac Resynchronisation Therapy

Auteurs: A. Ghani, A. H. E. M. Maas, P. P. H. M. Delnoy, A. R. Ramdat Misier, J. P. Ottervanger, A. Elvan

Gepubliceerd in: Netherlands Heart Journal | Uitgave 1/2011

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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.
Literatuur
1.
go back to reference Bazett HC. An analysis of the time-relations of electrocardiogram. Heart. 1920;7:353–70. Bazett HC. An analysis of the time-relations of electrocardiogram. Heart. 1920;7:353–70.
2.
go back to reference 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. PubMed 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. PubMed
3.
go back to reference Larsen JA, Kadish AH. Effects of gender on cardiac arrhythmia. J Cardiovasc Electrophysiol. 1998;9:655–64. PubMedCrossRef Larsen JA, Kadish AH. Effects of gender on cardiac arrhythmia. J Cardiovasc Electrophysiol. 1998;9:655–64. PubMedCrossRef
5.
go back to reference Josephson ME, Kastor JA. Supraventricular tachycardia: mechanisms and management. Ann Intern Med. 1977;87:346–58. PubMed Josephson ME, Kastor JA. Supraventricular tachycardia: mechanisms and management. Ann Intern Med. 1977;87:346–58. PubMed
6.
go back to reference Insulander P, Kenneback G, Straat E. Differences in dual AV nodal properties between men and women. Eur Heart J. 1999;20:568. abstract. Insulander P, Kenneback G, Straat E. Differences in dual AV nodal properties between men and women. Eur Heart J. 1999;20:568. abstract.
7.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
8.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
9.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
10.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
11.
go back to reference Elkayam M, Goodwin TM. Adenosine therapy for supraventricular tachycardia during pregnancy. Am J Cardiol. 1995;75:521–3. PubMedCrossRef Elkayam M, Goodwin TM. Adenosine therapy for supraventricular tachycardia during pregnancy. Am J Cardiol. 1995;75:521–3. PubMedCrossRef
12.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
13.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
14.
go back to reference Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers for right ventricular outflow tract tachycardia. Am Heart J. 2000;139:1009–13. PubMedCrossRef Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers for right ventricular outflow tract tachycardia. Am Heart J. 2000;139:1009–13. PubMedCrossRef
15.
16.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
17.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
18.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
19.
go back to reference Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States 1989 to1998. Circulation. 2001;104:2158–63. PubMedCrossRef Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States 1989 to1998. Circulation. 2001;104:2158–63. PubMedCrossRef
20.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
21.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
22.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
23.
go back to reference 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. PubMed 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. PubMed
24.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
25.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
26.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
27.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
28.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
29.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
30.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
31.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
32.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
33.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
34.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
35.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
36.
go back to reference 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. PubMedCrossRef 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. PubMedCrossRef
Metagegevens
Titel
Sex-Based Differences in Cardiac Arrhythmias, ICD Utilisation and Cardiac Resynchronisation Therapy
Auteurs
A. Ghani
A. H. E. M. Maas
P. P. H. M. Delnoy
A. R. Ramdat Misier
J. P. Ottervanger
A. Elvan
Publicatiedatum
01-01-2011
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 1/2011
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-010-0050-8

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