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Review
. 2021 Feb 2;22(3):1464.
doi: 10.3390/ijms22031464.

Sexual Dimorphisms, Anti-Hormonal Therapy and Cardiac Arrhythmias

Virginie Grouthier  1 , Melissa Y Y Moey  2 , Estelle Gandjbakhch  3 , Xavier Waintraub  3 , Christian Funck-Brentano  4 , Anne Bachelot  5 , Joe-Elie Salem  4   6
Affiliations
Review

Sexual Dimorphisms, Anti-Hormonal Therapy and Cardiac Arrhythmias

Virginie Grouthier et al. Int J Mol Sci. .

Abstract

Significant variations from the normal QT interval range of 350 to 450 milliseconds (ms) in men and 360 to 460 ms in women increase the risk for ventricular arrhythmias. This difference in the QT interval between men and women has led to the understanding of the influence of sex hormones on the role of gender-specific channelopathies and development of ventricular arrhythmias. The QT interval, which represents the duration of ventricular repolarization of the heart, can be affected by androgen levels, resulting in a sex-specific predilection for acquired and inherited channelopathies such as acquired long QT syndrome in women and Brugada syndrome and early repolarization syndrome in men. Manipulation of the homeostasis of these sex hormones as either hormonal therapy for certain cancers, recreational therapy or family planning and in transgender treatment has also been shown to affect QT interval duration and increase the risk for ventricular arrhythmias. In this review, we highlight the effects of endogenous and exogenous sex hormones in the physiological and pathological states on QTc variation and predisposition to gender-specific pro-arrhythmias.

Keywords: QT; anticancer drugs; atrial fibrillation; sex; ventricular arrhythmias.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
QTc duration as a function of gender (blue for males and pink for females) and main cardiac proarrhythmogenic channelopathies. Horizontal rectangular bars represent the range of QTc for normal and proarrhythmogenic channelopathies. Darker gradient color within the horizontal rectangular bars represents an increased risk for arrhythmia. Vertical rectangular bars represent the prevalence for these conditions as a function of gender. DiLQTS: drug-induced long QT syndrome, LQTS(X): congenital long QT syndrome type (X), ERS: early repolarization syndrome, BrS: Brugada syndrome, SQS: short QT syndrome.
Figure 2
Figure 2
Representation of the influence of different endogenous sex hormones and hormonal therapy on ventricular repolarization. Abbreviations: ADT—androgen deprivation therapy, AIs—aromatase inhibitors, SERMs—selective estrogen receptor modulators.
See this image and copyright information in PMC

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