Sex/Gender Differences in Arrhythmia

Men and women exhibit distinct structural and electrophysiological characteristics, which underlie variations in epidemiological features, disease progression, symptom expression, treatment approaches, and treatment response in various arrhythmias. Women are known to have a higher risk of stroke than men when atrial fibrillation occurs, and their poststroke clinical course tends to be worse. Furthermore, although more women than men report arrhythmia-related symptoms, they relatively less often receive medication or sinus rhythm control interventions, such as catheter ablation. While there is no difference in the risk of bleeding due to anticoagulant use for stroke prevention between men and women, women are more prone to QT-interval prolongation and Torsades de Pointes. Therefore, extra caution is necessary when administering antiarrhythmic agents like dronedarone, sotalol, and amiodarone. Hereditary arrhythmia disorders, such as congenital long QT syndrome and Brugada syndrome, demonstrate striking sex/gender differences related to sudden death. These disparities stem from sex/gender variations in ion channel mutations and repolarization processes and are known to be influenced by sex hormones.