From Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, Canada.
Circulation. 2017 Feb 7;135(6):593-608. doi: 10.1161/CIRCULATIONAHA.116.025312.
Sex-specific differences in the epidemiology, pathophysiology, clinical presentation, clinical treatment, and clinical outcomes of atrial fibrillation (AF), sustained ventricular arrhythmias, and sudden cardiac death are recognized. Sex hormones cause differences in cardiac electrophysiological parameters between men and women that may affect the risk for arrhythmias. The incidence and prevalence of AF is lower in women than in men. However, because women live longer and AF prevalence increases with age, the absolute number of women with AF exceeds that of men. Women with AF are more symptomatic, present with more atypical symptoms, and report worse quality of life in comparison with men. Female sex is an independent risk factor for death or stroke attributable to AF. Oral anticoagulation therapy for stroke prevention has similar efficacy for men and women, but older women treated with warfarin have a higher residual risk of stroke in comparison with men. Women with AF are less likely to receive rhythm control antiarrhythmic drug therapy, electric cardioversion, or catheter ablation in comparison with men. The incidence and prevalence of sustained ventricular arrhythmias and sudden cardiac death are lower in women than in men. Women receiving implantable cardioverter defibrillators for primary prevention of sudden cardiac death are less likely to experience sustained ventricular arrhythmias in comparison with men. In contrast, women receiving a cardiac resynchronization therapy implantable cardioverter defibrillator for the treatment of heart failure are more likely to benefit than men. Women are less likely to be referred for implantable cardioverter defibrillator therapy despite current guideline recommendations. Women are more likely to experience a significant complication related to implantable cardioverter defibrillator implantation in comparison with men. Whether sex differences in treatment decisions reflect patient preferences or treatment biases requires further study.
已经认识到，性别在心房颤动（房颤）、持续性室性心律失常和心源性猝死的流行病学、病理生理学、临床表现、临床治疗和临床结局方面存在差异。性激素导致男女之间的心脏电生理参数存在差异，这可能会影响心律失常的风险。女性房颤的发病率和患病率低于男性。然而，由于女性寿命更长，且随着年龄的增长房颤的患病率增加，患有房颤的女性绝对人数超过了男性。与男性相比，患有房颤的女性症状更明显，表现出更不典型的症状，生活质量更差。女性是房颤引起的死亡或卒中的独立危险因素。预防卒中的口服抗凝治疗对男性和女性的疗效相似，但与男性相比，接受华法林治疗的老年女性卒中的残余风险更高。与男性相比，患有房颤的女性接受节律控制抗心律失常药物治疗、电复律或导管消融的可能性更低。持续性室性心律失常和心源性猝死的发病率和患病率在女性中低于男性。与男性相比，因预防心源性猝死而植入植入式心律转复除颤器的女性发生持续性室性心律失常的可能性较低。相反，与男性相比，因心力衰竭而接受心脏再同步治疗植入式心律转复除颤器治疗的女性更可能受益。尽管有现行指南建议，但女性接受植入式心律转复除颤器治疗的可能性较低。与男性相比，女性因植入式心律转复除颤器植入而发生严重并发症的可能性更高。治疗决策中的性别差异是否反映了患者的偏好或治疗偏见，需要进一步研究。
