Incidence and management of arrhythmias in women

There are gender-specific differences in the nature and frequency of specific cardiac arrhythmias. Sex-specific variations in the electrophysiologic structure of the heart and/or hormonal effects on modulating ionic channel function may help to explain some of these differences, such as the increased prevalence of symptoms of congenital long QT syndrome in women, and the increase in episodes of supraventricular tachycardia in the perimenstrual period in susceptible patients. On the other hand, women suffer only 20% of sudden cardiac deaths. Fewer women than men have been enrolled in clinical trials for the treatment of ventricular arrhythmias because of difficulty in recruiting female patients, exclusion of women due to comorbid conditions, and/or the later appearance of coronary artery disease in females compared to males. Management of arrhythmias in women is often different from that in men, as women are less likely to receive a dual-chamber pacemaker and to have automatic defibrillator implantation, even when clinically appropriate. These differences may be due to the smaller size of women, a difference in the frequency of comorbid conditions, and patient preference, with women more likely to decline aggressive therapy. This article discusses the differences in presentation and the frequency of specific arrhythmias in women, and suggests measures to improve arrhythmia management in the female patient.