Atrial Fibrillation in Women

Atrial fibrillation (AF) is the most prevalent clinically relevant cardiac arrhythmia in women and men. The disease is associated with increased morbidity, in particular due to ischemic stroke and heart failure, and mortality. AF incidence and prevalence are lower in women than in men. The lifetime risk of AF is estimated to be up to 30% and higher for both sexes. The evidence regarding underlying risk factors and relevant comorbidities of AF in women versus men is conflicting. Women with AF are more symptomatic and report a lower quality of life than men. Their risk for complications, in particular ischemic stroke, is higher in conjunction with comorbidities. The biological principles underlying these sex differences are insufficiently understood. Differences in treatment can be observed, e.g. less rhythm control treatment in women. Treatment should be guided by the ABC (Avoid stroke, Better symptom management, Cardiovascular and comorbidity risk reduction) pathway. The higher ischemic stroke risk and higher symptom burden of women should be considered. In conclusion, physicians should be aware of sex differences between men and women in AF risk, manifestation, and treatment to appropriately address the specific needs and risks.