Arrhythmias in Female Patients: Incidence, Presentation and Management

Abstract

There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.

Chronic Kidney Disease Induces Proarrhythmic Remodeling

“…73 In general, females exhibit faster ambient heart rates, faster AV nodal and ventricular conduction, and slower ventricular repolarization when compared with males. 74 No studies to our knowledge have explicitly examined the interaction between sex, renal disease, and cardiac arrhythmogenesis on a molecular level. Our results suggest that sex-specific changes in CKD-associated cardiac gene expression may indeed play an important role in the protective effect of female sex on CV mortality in CKD.…”

Continuous Ambulatory Wireless Cardiac Monitoring: A Screening Tool for Cardiac Rhythm Disorders

“…[4] The incidence of arrhythmias in the younger generation is increasing and is occurring in premenopausal women. [5] In addition to gender differences in presentation, higher comorbidity associations, sedentary lifestyle, increased alcohol consumption due to acculturation, work stress, and the ability to balance home and work may all be important risk factors. Emotional factors may exhibit both substrate and triggering relationships with arrhythmia and also influence the risk of acquiring arrhythmia by affecting the stability of repolarization by prolonging the QTc interval.…”

A Scientific Imperative as Seen Through a Sharpened Lens: Sex, Gender, and the Cardiovascular Condition

“…3,[5][6][7][8] Finally, and concerningly, is the consistent finding that available cardiovascular interventions are often not similarly effective in females compared with males, likely due to a combination of factors including sex differences in biological response, gender differences in patterns of prescribing or titrating therapies, and available therapies themselves being functionally inadequate or mismatched for the treatment of femalespecific cardiovascular conditions. [3][4][5][6]10,11 The scientific imperative is now ever clear. Notwithstanding foundational achievements to date, much of what we currently understand about cardiovascular risk in females stems from predominantly descriptive data on sex differences.…”

“…3,5–8 Finally, and concerningly, is the consistent finding that available cardiovascular interventions are often not similarly effective in females compared with males, likely due to a combination of factors including sex differences in biological response, gender differences in patterns of prescribing or titrating therapies, and available therapies themselves being functionally inadequate or mismatched for the treatment of female-specific cardiovascular conditions. 3–6,10,11…”