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Cardiology Review

Clinical Articles, News & Views

Gender differences in arrhythmia

The various differences of cardiac electrophysiology and arrhythmia between genders are detailed in a systematic literature review,1 published recently in Cardiology Review.

Women have faster resting heart rates yet longer QTc intervals, the authors found. They also have shorter PR and QRS intervals; these are presumed to be due to the small heart size of women and hormonal effects on ion channels. Women are two times more likely to experience atrioventricular nodal re-entry tachycardia than men.

In contrast to atrioventricular nodal re-entry tachycardia, the study showed, accessory-pathway–mediated atrial arrhythmias are less common in women, and women have more concealed and fewer manifest accessory pathways. Supraventricular tachycardia in women varies with the menstrual cycle and is more frequent in the luteal phase and inversely correlated with oestrogen levels, it was found.

Atrial fibrillation (AF) is less prevalent in women, but the absolute number of women with AF is higher because AF prevalence increases with age and women live longer. Also, complications of AF are greater in women, authors said.

Women are generally less prone to ventricular arrhythmias, but they comprise a higher percentage of symptomatic subjects with congenital long QT syndrome and are more often affected by drugs that prolong the QT. Women are less prone to arrhythmias during pregnancy although they commonly complain of palpitations, which are sometimes related to the increase in heart rate during pregnancy, they concluded.

The authors recommend that clinicians should explore the relationship of arrhythmias to the menstrual cycle in female patients, and should know that the menstrual cycle may affect the induction of arrhythmias during electrophysiological testing. Clinicians should also be aware that the arrhythmia and the result of clinical trials examining arrhythmia treatment may have different implications in women than in men, they add.


1. Gowd P, Thompson P. Effect of female sex on cardiac arrhythmias. Cardiol Rev 2012;20:297–303.

Published on: January 25, 2013

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