Skip to main content
NCBI home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;25(2):49–56. doi: 10.1002/clc.4950250203

Gender differences in arrhythmias

Deborah Wolbrette 1,✉, Gerald Naccarelli 1, Anne Curtis 2, Michael Lehmann 3, Alan Kadish 4
PMCID: PMC6653934  PMID: 11841151

Abstract

Electrocardiographic and electrophysiologic differences between men and women have long been noted. Women have a higher intrinsic heart rate than men, along with a longer corrected QT interval and a shorter sinus nodal recovery time. The incidence of and risk factors for a variety of arrhythmias differ between men and women. Atrioventricular nodal reentry tachycardia has a 2:1 female‐to‐male predominance, while accessory pathways are twice as frequent in men. Although atrial fibrillation is more prevalent in men of all age groups, the absolute numbers of men and women with atrial fibrillation are equal, and the associated morbidity and mortality experienced by women with atrial fibrillation appear to be worse. Women have a lower incidence of sudden cardiac death, and female survivors of sudden cardiac death have a lower frequency of spontaneous or inducible ventricular tachycardia. On the other hand, drug‐induced torsade de pointes and symptomatic long QT syndrome have a female predominance. Therefore, greater caution should be used when prescribing QT‐prolonging drugs in women. The incidence of arrhythmias is increased during pregnancy, and management of pregnant patients poses a significant challenge. The mechanisms of these gender differences are unclear but may be related to hormonal effects and the shorter QT interval in adult males. Pharmacologic and nonpharmacologic therapies are usually equally efficacious, but the risks of pharmacologic therapy are different in men and women. Atrial fibrillation may be more difficult to treat in women.

Keywords: gender, arrhythmias, women, atrial fibrillation, sudden cardiac death, implantable cardioverter defibrillators, long QT syndrome

Full Text

The Full Text of this article is available as a PDF (128.6 KB).

References

  • 1. Bazett H: An analysis of the time relations of electrocardiograms. Heart 1920; 7:353–370 [Google Scholar]
  • 2. Ashman R: The normal duration of the QT interval. Am Heart J 1942; 23:522–534 [Google Scholar]
  • 3. Jose A, Collison D: The normal range and determinants of the intrinsic heart rate in man. Cardiovasc Res 1970; 4:160–167 [DOI] [PubMed] [Google Scholar]
  • 4. Larsen JA, Kadish AH: Effects of gender on cardiac arrhythmias. J Cardiovasc Electrophysiol 1998; 9:655–664 [DOI] [PubMed] [Google Scholar]
  • 5. Burke J, Goldberger J, Ehlert FA, Kruse JT, Parker MA, Kadish AH: Gender differences in heart rate before and after autonomic blockade: Evidence against an intrinsic gender effect. Am J Med 1996; 100:537–543 [DOI] [PubMed] [Google Scholar]
  • 6. Molnar J, Zhang F, Weiss J, Ehlert FA, Rosenthal JE: Diurnal pattern of QTc interval: How long is it prolonged? Possible relation to circadian triggers of cardiovascular events. J Am Coll Cardiol 1996; 27:76–83 [DOI] [PubMed] [Google Scholar]
  • 7. Burke JH, Ehlert FA, Kruse JT, Parker MA, Goldberger JJ, Kadish AH: Gender‐specific differences in the QT interval and the effect of autonomic tone and menstrual cycle in healthy adults. Am J Cardiol 1997; 79:178–181 [DOI] [PubMed] [Google Scholar]
  • 8. Rautaharju P, Zhou S, Wong S, Calhoun H, Berenson G, Prineas R, Davignon A: Sex differences in the evolution of the electrocardiographic QT interval with age. Can J Cardiol 1992; 8:690–695 [PubMed] [Google Scholar]
  • 9. Kligfield P, Lax K, Okin P: QT interval heart rate relation during exercise in normal men and women. Definition by linear regression analysis. J Am Coll Cardiol 1996; 28:1547–1555 [DOI] [PubMed] [Google Scholar]
  • 10. Stramba‐Badiale M, Locati E, Martinelli A, Courville J, Schwartz PJ: Gender and the relationship between ventricular repolarization and cardiac cycle length during 24‐hour Holter monitor recordings. Eur Heart J 1997; 18:1000–1006 [DOI] [PubMed] [Google Scholar]
  • 11. Merri M, Benhorin J, Alberti M, Locati E, Moss AJ: Electrocardiographic quantitation of ventricular repolarization. Circulation 1989; 80:1301–1308 [DOI] [PubMed] [Google Scholar]
  • 12. Yang H, Elko P, Fromm BS, Baga JJ, Pires LA, Schuger CD, Steinman RT, Lehmann MH: Maximal ascending and descending slopes of the T wave in men and women. J Electrocardiol 1997; 30:267–276 [DOI] [PubMed] [Google Scholar]
  • 13. Kadish AH: The effect of gender on cardiac electrophysiology and arrhythmias In Cardiac Electrophysiology: From Cell to Bedside, Second Edition (Eds. Zipes DP, Jalife J.), p. 1268–1275. Philadelphia: W.B. Saunders, 1995. [Google Scholar]
  • 14. Rodriguez LM, deChillou C, Schlapfer J, Metzger J, Baiyan XIE, van den Dool A, Smeets JLRM, Wellens HJJ: Age at onset and gender of patients with different types of supraventricular tachycardias. Am J Cardiol 1992; 70:1213–1215 [DOI] [PubMed] [Google Scholar]
  • 15. Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang SKS, Liem LB, Klein LS, Moser SA, Bloch DA, Gillette P, Prystowsky E: Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: Final results of a prospective, multicenter clinical trial. Circulation 1999; 99:262–270 [DOI] [PubMed] [Google Scholar]
  • 16. Swartz J, Tracy C, Fletcher R: Radiofrequency end catheter ablation of accessory atrioventricular pathway atrial insertion sites. Circulation 1993; 87:487–499 [DOI] [PubMed] [Google Scholar]
  • 17. Lessmeier TJ, Gamperling D, Johnson‐Liddon V, Fromm BS, Steinman RT, Meissner MD, Lehmann MH: Unrecognized paroxysmal supraventricular tachycardia. Arch Intern Med 1997; 157:537–543 [PubMed] [Google Scholar]
  • 18. Rosano GMC, Leonardo F, Sorrel PM, Beale CM, DeLuca F, Collins P: Cyclical variation in paroxysmal supraventricular tachycardia in women. Lancet 1996; 347:786–788 [DOI] [PubMed] [Google Scholar]
  • 19. Myerburg RJ, Cox MM, Interian A, Mitrani R, Girgis I, Dylewski J, Castellanos A: Cycling of inducibility of paroxysmal supraventricular tachycardia in women and its implications for timing of electrophysiologic procedures. Am J Cardiol 1999; 83:1049–1054 [DOI] [PubMed] [Google Scholar]
  • 20. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA: Independent risk factors for atrial fibrillation in a population‐based cohort: The Framingham Study. J Am Med Assoc 1994; 271:840–844 [PubMed] [Google Scholar]
  • 21. Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS: Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). Am J Cardiol 1998; 61:714–717 [DOI] [PubMed] [Google Scholar]
  • 22. Feinberg WM, Blackshear JL, Laupacis A, Kronmol R, Hart RG: Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med 1995; 155:469–473 [PubMed] [Google Scholar]
  • 23. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D: Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation 1998; 98:946–952 [DOI] [PubMed] [Google Scholar]
  • 24. Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner WS, for the Multicenter Study of Perioperative Ischemia Research Group : Atrial fibrillation following coronary artery bypass graft surgery. Predictors, outcomes, and resource utilization. J Am Med Assoc 1996; 276:300–306 [PubMed] [Google Scholar]
  • 25. Leitch JW, Thomson D, Baird DK, Harris PJ: The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990; 100:33–342 [PubMed] [Google Scholar]
  • 26. Cooklin M, Gold MR: Implications and treatment of atrial fibrillation after cardiothoracic surgery. Curr Opin Cardiol 1998; 13:20–28 [DOI] [PubMed] [Google Scholar]
  • 27. Cabin HS, Clubb S, Hall C, Perlmutter RA, Feinstein AR: Risk for systemic embolization of atrial fibrillation without mitral stenosis. Am J Cardiol 1990; 65:1112–1116 [DOI] [PubMed] [Google Scholar]
  • 28. Hnatkova K, Walstare JEP, Murgatroyd FD: Age and gender influences on rate and duration of paroxysmal atrial fibrillation. PACE 1998; 21:2455–2458 [DOI] [PubMed] [Google Scholar]
  • 29. Suttorp MJ, Kingma H, Koomen EM, Hof AV, Tijssen JE, Lie KI: Recurrence of paroxysmal atrial fibrillation or flutter after successful cardioversion in patients with normal left ventricular function. Am J Cardiol 1993; 71:710–713 [DOI] [PubMed] [Google Scholar]
  • 30. Rubart M, Von der Lohe E: Sex steroids and cardiac arrhythmia: More questions than answers. J Cardiovasc Electrophysiol 1998; 9:665–667 [DOI] [PubMed] [Google Scholar]
  • 31. Kannel WB, Wilson PWF, D'Agostino RB, Cobb J: Sudden coronary death in women. Am Heart J 1998; 136:205–212 [DOI] [PubMed] [Google Scholar]
  • 32. Albert CM, McGovern BA, Newell JB, Ruskin JN: Sex differences is cardiac arrest survivors. Circulation 1996; 93:1170–1176 [DOI] [PubMed] [Google Scholar]
  • 33. Buxton AE, Hafley GE, Lehmann MH, Gold M, O'Toole M, Tang A, Coromilas J, Hook B, Stamato NJ, Lee KL: Prediction of sustained ventricular tachycardia inducible by programmed stimulation in patients with coronary artery disease: Utility of clinical variables. Circulation 1999; 99:1843–1850 [DOI] [PubMed] [Google Scholar]
  • 34. Olsson G, Wikstrand J, Warnold I, MangerCats V, McBoyle D, Herlitz J, Hjalmarson A, Sonnenblick EH: Metoprolol‐induced reduction in postinfarction mortality: Pooled results from five double‐blind randomized trials. Eur Heart J 1992; 13:28–32 [DOI] [PubMed] [Google Scholar]
  • 35. Kudenchuk PJ, Bardy GH, Poole JE, Dolock GL, Gleva MJ, Reddy R, Jones GK, Troutman C, Anderson J, Johnson G: Malignant sustained ventricular tachyarrhythmias in women: Characteristics and outcome of treatment with an implantable crdioverter defibrillator. J Cardiovasc Electrophysiol 1997; 8(1): 2–10 [DOI] [PubMed] [Google Scholar]
  • 36. Engelstein ED, Friedman PL, Yao Q, Coromilas J, Beckman KJ, Buxton AE, Flynn D, Firth B, Delamagas H, Ledingham R, Schron EB: Gender differences in patients with life‐threatening ventricular arrhythmias: Impact on treatment and survival in the antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation 1997; 96(suppl): 1–720 [Google Scholar]
  • 37. Makkar R, Fromm B, Steinman R: Female gender as a risk factor for torsade de pointes associated with cardiovascular drugs. J Am Med Assoc 1993; 270:2590–2597 [DOI] [PubMed] [Google Scholar]
  • 38. Pratt CM, Camm AJ, Cooper W, Friedman PL, MacNeil DJ, Moulton KM, Pitt B, Schwartz PJ, Veltri EP, Waldo AL: Mortality in the Survival With ORal D‐sotalol (SWORD) trial: Why did patients die? Am J Cardiol 1998; 81:869–876 [DOI] [PubMed] [Google Scholar]
  • 39. Lehmann MH, Hardy S, Archibald D, Quart B, MacNeil DJ: Sex difference in risk of torsade de pointes with d, l‐sotalol. Circulation 1996; 94:2534–2541 [DOI] [PubMed] [Google Scholar]
  • 40. Lehmann MH, Hardy S, Archibald D, MacNeil DJ: JTc prolongation with d, l‐sotalol in women versus men. Am J Cardiol 1999; 83:354–359 [DOI] [PubMed] [Google Scholar]
  • 41. Torp‐Pedersen C, Moller M, Bloch‐Thomsen PE, Kober L, Sandoe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ, for the Danish Investigations of Arrhythmia & Mortality on Dofetilide Study Group : Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med 1999; 34:857–865 [DOI] [PubMed] [Google Scholar]
  • 42. Karam R, Marcello S, Brooks RR, Corey AE, Moore A: Azimilide dihydrochloride, a novel antiarrhythmic agent. Am J Cardiol 1998; 81(6A): 40D–46D [DOI] [PubMed] [Google Scholar]
  • 43. Camm AJ, Karam R, Pratt CM: The azimilide post‐infarct survival evaluation (ALIVE) trial. Am J Cardiol 1998; 81(6A): 35D–39D [DOI] [PubMed] [Google Scholar]
  • 44. Reinoehl J, Frankovich D, Machado C, Kawasaki R, Baga JJ, Pires LA, Steinman RT, Fromm BS, Lehmann MH: Probucol‐associated tachyarrhythmic events and QT prolongation: Importance of gender. Am Heart J 1996; 131:1184–1191 [DOI] [PubMed] [Google Scholar]
  • 45. Drici MD, Knollmann B, Wang W‐X, Woosley RL: Gender and reports of erythromycin‐related arrhythmias. Circulation 1997; 96:1–211 [Google Scholar]
  • 46. Woosley RL, Chen Y, Freiman JP, Gillis RA: Mechanism of the cardiotoxic actions of terfenadine. J Am Med Assoc 1993; 269:1532–1536 [PubMed] [Google Scholar]
  • 47. Kawasaki R, Machado C, Reinoehl J: Increased propensity of women to develop torsade de pointes during complete heart block. J Cardiovasc Electrophysiol 1995; 6:1032–1038 [DOI] [PubMed] [Google Scholar]
  • 48. Moss AJ, Schwartz PJ, Crampton RS, Tzivoni D, Locati EH, MacCluer J, Jackson Hall W, Weitkamp L, Vincent GM, Garson JA, Robinson JL, Benhorin J, Choi S: The long QT syndrome. Prospective longitudinal study of 328 families. Circulation 1991; 84:1136–1144 [DOI] [PubMed] [Google Scholar]
  • 49. Lehmann MH, Timothy KW, Frankovich D, Fromm BS, Keating M, Locati EH, Taggart RT, Towbin JA, Moss AJ, Schwartz PJ, Vincent GM: Age‐gender influence on the rate‐corrected QT interval and the QT‐heart rate relation in families with genotypically characterized long QT syndrome. J Am Coll Cardiol 1997; 29:93–99 [DOI] [PubMed] [Google Scholar]
  • 50. Locati EH, Zareba W, Moss AJ, Schwartz PJ, Vincent GM, Lehmann MH, Towbin JA, Priori SG, Napolitano C, Robinson JL, Andrews M, Timothy K, Hall J: Age‐ and sex‐related differences in clinical manifestations in patients with congenital long‐QT syndrome: Findings from the International LQTS Registry. Circulation 1998; 97:2237–2244 [DOI] [PubMed] [Google Scholar]
  • 51. Rashba EJ, Zareba W, Moss AJ, Hall WJ, Robinson J, Locati EH, Schwartz PJ, Andrews M, for the LQTS Investigators : Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. Circulation 1998; 97:451–456 [DOI] [PubMed] [Google Scholar]
  • 52. Tawam M, Levine J, Mendelson M, Goldberger J, Dyer A, Kadish A: Effect of pregnancy on paroxysmal supraventricular tachycardia. Am J Cardiol 1993; 72:838–840 [DOI] [PubMed] [Google Scholar]
  • 53. Widerhorn J, Widerhorn A, Rahimtoola S, Elkayam U: WPW syndrome during pregnancy: Increased incidence of supraventricular arrhythmias. Am Heart J 1992; 123:769–798 [DOI] [PubMed] [Google Scholar]
  • 54. Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M: New onset ventricular tachycardia during pregnancy. Am Heart J 1992; 123:933–941 [DOI] [PubMed] [Google Scholar]
  • 55. Wolbrette D, Patel H: Arrhythmias and women. Curr Opin Cardiol 1999; 14:36–43 [DOI] [PubMed] [Google Scholar]
  • 56. Natale A, Davidson T, Geiger MJ, Newby K: Implantable cardio‐verter‐defibrillators and pregnancy: A safe combination? Circulation 1997; 96:2808–2812 [DOI] [PubMed] [Google Scholar]
  • 57. Roden DM, Spooner PM: Inherited long QT syndromes: A paradigm for understanding arrhythmogenesis. J Cardiovasc Electrophysiol 1999; 10:1664–1683 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES