About this Research Topic

Background

It is increasingly recognized that the epidemiology, disease course, and response to treatment of cardiac arrhythmias in women differ significantly from that of men. There are known biological differences in cardiac electrophysiology. Women have higher resting heart rates and longer baseline electrocardiographic QT intervals which affect arrhythmic risk. Compared to men, women with atrial fibrillation have a higher age-adjusted mortality and stroke risk, worse morbidity and quality of life, and an increased propensity for proarrhythmic-related drug effects. Atrioventricular nodal reentry tachycardia is more prevalent among women and hormonal levels may affect the frequency of tachycardia. Women have different prevalences of structural heart disease which may in part explain a decreased prevalence of ventricular arrhythmias compared to men.

Nonischemic, rather than ischemic, cardiomyopathy is more common in women. This difference in cardiomyopathy etiology may explain the higher prevalence in women of pulseless electrical activity compared to ventricular fibrillation as the cause of sudden cardiac death. Female sex is associated with a greater risk for procedural complications from both atrial and ventricular ablation procedures as well as higher recurrence rates.

There is a need to better understand how sex-based differences in patient characteristics, the underlying myocardial substrate as well as triggers affect arrhythmic risk in women. This includes but is not limited to investigating how women differ from men with respect to cardiac structure and function; autonomic dysregulation; psychological stress or reaction to stress; systemic inflammation; as well as comorbidities, hormone levels and responses to pharmacotherapy. There continues to be an under-enrollment of women in clinical trials which limits our understanding. Women are often diagnosed later in the disease course, and/or treated less aggressively for arrhythmias, yet suffer more adverse effects from treatment and interventions. These gaps in knowledge limit optimal individualization of care of women at risk for or presenting with cardiac arrhythmias.

The scope of the Research Topic includes how sex impacts pathophysiology, epidemiology, presentation, diagnosis, risk stratification approaches, therapy, management and prognosis of cardiac arrhythmias, channelopathies and sudden cardiac arrest/death. We are particularly interested in clinical and translational work including Original Research and Systematic Reviews/meta-analyses but will also consider foundational work.

Keywords: atrial arrhythmia, ventricular arrhythmia, sex, sudden cardiac death, risk stratification, women

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