[Cardiac arrhythmias and sudden cardiac death in women]

Abstract

Background: Gender specific cardiac arrhythmias have been recognized for more than 80 years. The impact of gonadal steroids on the autonomic system and on the cellular electrophysiology of the cardiac autonomic system are discussed as is a direct genetic disposition on a cellular, functional or metabolic level. We nevertheless have to be aware of age- and gender-specific differences of heart diseases, which have an impact on the incidence, form and severity of cardiac arrhythmias.

Cardiac arrhythmias in women: Gender-specific electrophysiologic differences like a higher basic heart rate and a longer QT-interval, beginning after puberty, are the main changes in ECGs in women and have a strong relationship to constitutional and hormonal influences. Supraventricular arrhythmias, i. e. in women sinus and AV-nodal-reentry tachycardias, less frequently Wolff-Parkinson-White tachycardias, may show clearly cyclical differences. Atrial fibrillation is more frequent in women, is more symptomatic, and there are more problems in therapy. Ventricular arrhythmias, occurring equally in healthy persons, show a strong relationship to coronary artery disease in men, which is less significant in women (in women more arrhythmogenic co-factors). Women suffer from acquired and congenital long-QT syndrome, and consequently more often from torsade-de-pointes tachycardias (stronger drug-induced QT-lengthening, more short-long sequences, differences in Ikr sensitivity). Sudden cardiac death is three times more often in men. Women suffer from it about ten years later; it is a more heterogenous phenomenon than in men, and the prognosis is worse. Women are underrepresented in controlled studies for primary and secondary prevention compared to men.

Conclusions: As the underlying reasons of gender-specific differences in cardiac arrhythmias are not known in detail, the findings discussed imply the necessity of more basic studies to evaluate gender-specific solutions for risk stratification and therapy.