Key result
Females face distinct arrhythmia patterns yet receive fewer referrals for electrical therapies than males.
Despite significant gender differences in cardiac electrophysiology and arrhythmia incidence, women remain underrepresented in clinical trials and lack gender-specific guideline recommendations for electrical therapies.
Sex differences in electrophysiology and referral patterns warrant clinical awareness; leaves open whether sex-stratified trials will close equity gaps.
The difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Interestingly, cardiovascular structural and electrophysiological remodelling promoted by exercise training enhances this 'gender effect'. Despite all these relevant issues, we lack gender specific recommendations in the current guidelines for electrical therapies for heart rhythm disorders and heart failure. Even more, we continue to see that fewer women are included in clinical trials and are less referred than men for these treatments.
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Boriani et al. (2017) conducted a review in Arrhythmias and heart failure. Female sex vs. Male sex was evaluated. Females present distinct electrophysiological characteristics and arrhythmia epidemiology compared to males, yet remain underrepresented in clinical trials and are less frequently referred for electrical therapies.
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