Use of Antiarrhythmic Medications in Women

Lampert, Rachel

doi:10.15420/ecr.2010.6.4.70

Cited by 3 publications

(5 citation statements)

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“…It is known that treatment with antiarrhythmic drugs leads to a higher rate of proarrhythmic events in females, including torsade de pointes, arising from QT interval prolongation. 8 , 9 Older patients are also at higher risk for proarrhythmia with antiarrhythmic drugs, potentially because of a lower rate of clearance of the drugs from the body 1 and due to the increased prevalence of chronic kidney disease and concomitant structural heart disease. 14 In the primary analysis of the ATHENA trial, dronedarone treatment was associated with prolongation of the QT interval compared with placebo, but only a single case of torsade de pointes was reported, in a 66-year-old female patient with multiple comorbidities, who still presented with ventricular arrhythmias months after dronedarone wash-out (data on file).…”

Section: Discussionmentioning

confidence: 99%

“…Antiarrhythmic drugs are associated with a higher risk of proarrhythmic events in older populations 1 and in females. 8 , 9 However, dronedarone is generally associated with a lower risk of proarrhythmia compared with other antiarrhythmic drugs. 10 In this post hoc analysis of ATHENA, we assessed the efficacy and safety of dronedarone treatment among subgroups of patients of varying ages (<65 years, 65–74, and ≥75 years), and across males and females.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of dronedarone across age and sex subgroups: apost hocanalysis of the ATHENA study among patients with non-permanent atrial fibrillation/flutter

et al. 2021

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Aims Age and sex may impact the efficacy of antiarrhythmic drugs on cardiovascular outcomes and arrhythmia recurrences in patients with atrial fibrillation (AF). We report on a post hoc analysis of the ATHENA study (NCT00174785), which examined cardiovascular outcomes in patients with non-permanent AF treated with dronedarone vs. placebo. Methods and results Efficacy and safety of dronedarone were assessed in patients according to age and sex. Baseline characteristics were comparable across subgroups, except for cardiovascular comorbidities, which were more frequent with increasing age. Dronedarone significantly reduced the risk of cardiovascular hospitalization or death due to any cause among patients 65–74 [n = 1830; hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.60–0.83; P < 0.0001] and ≥75 (n = 1925; HR 0.75, 95% CI 0.65–0.88; P = 0.0002) years old and among males (n = 2459; HR 0.74, 95% CI 0.64–0.84; P < 0.00001) and females (n = 2169; HR 0.77, 95% CI 0.67–0.89; P = 0.0002); outcomes were similar for time to AF/AFL recurrence. Among patients aged <65 years (n = 873), cardiovascular hospitalization or death due to any cause with dronedarone vs. placebo was associated with an HR of 0.89 (95% CI 0.71–1.11; P = 0.3). The incidence of all treatment-emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation was comparable among males and females, and increased with increasing age. Conclusions These results support the use of dronedarone for the improvement of clinical outcomes among patients aged ≥65 years and regardless of sex.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of dronedarone across age and sex subgroups: apost hocanalysis of the ATHENA study among patients with non-permanent atrial fibrillation/flutter

et al. 2021

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“…This has been attributed to a lower density of IKr (a major repolarizing outward potassium channel) in women than men. This could be a possible explanation for longer QT in female hearts [49].…”

Section: Testosterone Shortens Qt Intervalmentioning

confidence: 95%

“…However, women show an increased reactivity to sympathetic stimuli, with a greater QT prolongation compared with men. This could be another etiology for increased antiarrhythmic toxicity with autonomic stress in women [46][47][48][49].…”

Section: Testosterone Shortens Qt Intervalmentioning

confidence: 99%

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Bridging the gender gap in atrial fibrillation

Oza

Baveja

Tedrow

2015

Expert Review of Cardiovascular Therapy

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Women have a similar lifetime prevalence of non-valvular atrial fibrillation (NVAF) compared with that of men. Given the significant morbidity and potential mortality associated with NVAF, it is crucial to understand gender differences with NVAF. Women can be more symptomatic than men. Despite a higher baseline stroke risk, they are less likely to be on anticoagulation. Women have a greater risk of thromboembolism and a similar rate of bleeding risk compared with men on anticoagulation. Initial experience suggests that novel oral anticoagulants have similar safety and efficacy profile in men and women. Although women can have more adverse reactions from antiarrhythmic therapies, they are often referred later than men for ablation. As a group, a mitigating factor in ablation referral is that women also have a higher incidence of procedural complications from catheter ablation. This review summarizes the available literature highlighting significant gender-based differences and also highlights areas for research to improve NVAF outcomes in women.

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