Arrhythmia & Electrophysiology Review 2013;2(1):41-4
The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.
Gender seems to have a major impact on the outcome of invasive electrophysiological procedures, due to differences in epidemiology and clinical presentation of cardiac arrhythmias, coupled with differences in procedural success and complications. Typically, females with arrhythmias suitable for catheter ablation (e.g. AF and other supraventricular arrhythmias) are referred later to such procedures, which might in part explain the reported differences in outcomes. With regard to implantation of cardiac devices, such as ICD and CRT, the reported gender-related differences in outcomes could be explained by substantial differences in the epidemiology, underlying substrates and clinical course of females with severe left ventricular dysfunction.
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