A Focus On: Gender Differences in Hearth Rhythm Management

A Focus On: Gender Differences in Heart Rhythm Management


Total Enrollment of Men and Women in Implantable Cardioverter-Defibrillator Trials. (Adapted  from  Lampert R. Implantable  cardioverter-defibrillator use  and  benefit  in  women. Cardiol Rev. 2007 Nov-Dec;15[6]:298–303. Used with permission.) Reproduced from the upcoming Oxford University Press title Arrhythmias in Women: Diagnosis and Treatment, publication date September 2014.



‘A man does what he can; a woman does what a man cannot.’ 
-Isabel Allende, Inés of My Soul


Heart disease in men and women is not always the same disease process. The disparity in the incidence and treatment of coronary artery disease in women compared to men is well understood, but less well known is the differences in heart rhythm management between the sexes. Sex matters in the fundamental electrophysiologic properties of the cardiac myocardium, the effects of female sex hormones, and the dynamic effects of hormonal regulation that occur throughout the life cycle in both sexes.


Women have less repolarization reserve than men, and are therefore more susceptible to drug-mediated pro-arrhythmic effects.  Women with atrial fibrillation have higher incidence of stroke than men.  Fewer women compared to men receive appropriate device therapy based on current clinical guidelines.  Women are less likely than men to have left ventricular dysfunction at the time of sudden death, underscor­ing the difficulty in applying traditional risk algorithms for sudden death prevention in women. Are clinical algorithms skewed because of biological differences between the sexes, because clinical trials evaluating risk of sudden death have included predominantly men, or both?  Because women have been grossly underrepresented in clinical trials evaluating arrhythmia management, many questions remain as to whether women will benefit from these therapies to the same extent as men. 


The management of arrhythmias and implantable cardiac devices during pregnancy presents unique clinical challenges.  A growing population of women with congenital heart disease and associated arrhythmias has reached child-bearing age, and require specialized cardiac care during pregnancy.


The prevalence of cardiac arrhythmias in both sexes varies markedly in different countries as a result of geography, socioeconom­ics, ethnicity and genetic background, culture, and environmental factors.  Understanding the differences between the recognition and treatment of arrhythmias in women and men is not only a matter of social correctness but literally is a matter of life and death.  


Joseph G. Murphy is Professor of Medicine, College of Medicine, and Consultant, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA, and Margaret A. Lloyd is Assistant Professor of Medicine, College of Medicine, and Consultant, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA


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