Gender Differences in Cardiac Arrhythmias

Zusammenfassung Klinische und experimentelle Beobachtungen zeigen geschlechtsspezifische Unterschiede in der myozellulären und invasiven Elektrophysiologie. Diese Unterschiede zeigen sich in leichten Unterschieden in elektrophysiologischen und elektrokardiographischen Basisparametern, wobei bei Frauen im Vergleich zu Männern dem etwas längeren QT–Intervall die klinisch größte Bedeutung zukommt. Bei Männern stehen klinisch eine höhere Inzidenz von Vorhofflimmern, Präexzitation und ventrikulären Tachykardien im Vordergrund. Hormonelle Einflüsse und der autonome Tonus des Nervensystems stellen wichtige Modifikatoren des zellulären Milieus dar. Die Erforschung des Wechselspiels mit regionalen zellulären Faktoren lässt hoffen, geschlechtsspezifische Faktoren der Arrhythmogenese besser zu kennen und hinsichtlich der Therapie und Prävention von Herzrhythmusstörungen nutzbar zu machen.* Both authors contributed equally to the study.     

Cardiac Arrhythmias in Africa: Epidemiology,Management Challenges,and Perspectives

Africa is experiencing an increasing burden of cardiac arrhythmias. Unfortunately, the expanding need for appropriate care remains largely unmet because of inadequate funding, shortage of essential medical expertise, and the high cost of diagnostic equipment and treatment modalities. Thus, patients receive suboptimal care. A total of 5 of 34 countries (15%) in Sub-Saharan Africa (SSA) lack a single trained cardiologist to provide basic cardiac care. One-third of the SSA countries do not have a single pacemaker center, and more than one-half do not have a coronary catheterization laboratory. Only South Africa and several North African countries provide complete services for cardiac arrhythmias, leaving more than hundreds of millions of people in SSA without access to arrhythmia care considered standard in other parts of the world. Key strategies to improve arrhythmia care in Africa include greater government health care funding, increased emphasis on personnel training through fellowship programs, and greater focus on preventive care.     

Gender Differences in Cardiac Arrhythmias in the Elderly

Cardiac arrhythmias are a major source of morbidity and mortality in the elderly. Gender differences have been described in the incidence and clinical course of various arrhythmias in the elderly. Gender appears to influence response to therapies such as implantable cardiac devices. The purpose of this article is to review recent advances in this area of electrophysiology. Further research is required to enhance our current knowledge of this complex subject.     

心脏核磁共振成像与心内电生理

透视介导的心脏内电生理术一个主要缺点为术中无法正确识别软组织及其与比邻结构关系,然而,心脏核磁共振成像介导的心内电生理术却弥补了这一缺陷.心脏核磁共振成像-心内电生理术不仅可精确地展示出心脏的三维空间形态结构,而且能直接识别心律失常病灶及观察射频消融的疗效,提高复杂心律失常手术成功率及减少并发症有重要作用.因而,心脏核磁共振成像被认为在心内电生理领域具有广泛运用前景.     

Women and Peripheral Arterial Disease: A Review of Sex Differences in Epidemiology,Clinical Manifestations,and Outcomes

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women. Peripheral arterial disease (PAD), a manifestation of CVD and a marker for other adverse CVD outcomes such as ischemic heart disease and stroke, remains underrecognized and undertreated in women. Contrary to the previous belief that PAD is mainly a disease of white men, contemporary data suggest equal, if not higher, prevalence rates in nonwhite women. Women often present with asymptomatic or atypical disease and seek medical attention with more advanced disease. Cardiovascular morbidity and mortality rates, as well as procedural mortality rates, remain elevated in women compared with men. There are sex-specific markers and comorbidities with a higher female prevalence that are associated with PAD. Greater focus on PAD in cardiovascular trials, equivalent enrollment of women in large trials, and focused prevention strategies may help reduce the economic burden and adverse outcomes associated with PAD in women.     

Arrhythmias and Sudden Cardiac Death in End Stage Renal Disease: Epidemiology,Risk Factors,and Management

Patients with end-stage renal disease (ESRD) are predisposed to heart rhythm disorders resulting in significant morbidity and mortality. Bradyarrhythmia appears to be more prevalent than ventricular tachyarrhythmias. There is also a high incidence of sudden cardiac death (SCD) in this group of patients, which cannot be explained only by traditional cardiac risk factors. The reported incidence and prevalence of arrhythmias and SCD is quite variable mainly because of the different study populations and recording techniques. The mechanism of SCD in patients with ESRD is also not clear. Although traditionally the thinking has been that ventricular arrhythmias are the main contributor to SCD, recent studies with implantable loop recorders have highlighted the role of bradyarrhythmias. The pathophysiological processes resulting in arrhythmia and SCD in patients with ESRD are unique. Some of the risk factors, including dialysate composition, timing, and frequency, are modifiable and hence provide an option for interventions to potentially reduce SCD. In addition, there might be a relationship with the timing of dialysis with SCD tending to occur during the long interdialytic period. Patients with ESRD have a higher likelihood of requiring pacemaker implantation; however, they also have a higher risk of device-related complications. The limited data available regarding the role of the implantable cardioverter defibrillator to prevent SCD in patients with ESRD have shown conflicting results. Future research is needed to develop appropriate risk stratification tools to identify patients who will benefit from such interventions and to assess their safety and efficacy.     

Epidemiology,Mechanisms, and Management of Atrial Fibrillation in Cardiac Amyloidosis

Cardiac amyloidosis (CA) is a restrictive disease that results from intramyocardial amyloid deposition due to immunoglobulin light chain or transthyretin proteins. Up to two-third of CA patients have atrial fibrillation (AF) due to electromechanical, autonomic, and hemodynamic disturbances. AF in CA carries particularly increased risk of thromboembolism, prompting anticoagulation therapy irrespective of CHA₂DS₂VASc score. However, CA is also associated with enhanced bleeding risk that warrants thorough assessment of bleeding profile before initiation of anticoagulation. Management of AF in CA is challenging because these patients poorly tolerate rate control agents, while cardiomyopathy precludes most antiarrhythmic agents, leaving amiodarone as the preferred antiarrhythmic drug. The effectiveness of direct current cardioversion in restoring sinus rhythm in CA is comparable with that in the general population, although intraprocedural complication rates could be higher. Transesophageal echocardiogram should be performed prior to direct current cardioversion, given high incidence of intracardiac thrombus in these patients. Finally, the data on catheter ablation is limited.     

Sex Differences in Cardiac Rehabilitation Enrollment: A Meta-analysis

Background

The present systematic review and meta-analysis examines studies published in the past 10 years that described cardiac rehabilitation (CR) enrollment among women and men, to determine whether a significant sex difference persists despite the evidence supporting the benefits of CR to women as well as men.

Methods

Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the 623 selected full-text articles were independently screened based on predefined inclusion/exclusion criteria (guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA) and assessed for quality using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement form. The meta-analysis was undertaken using Review Manager software.

Results

Twenty-six eligible observational studies reporting data for 297,719 participants (128,499 [43.2%] women) were included. On average, 45.0% of men and 38.5% of women enrolled in CR. In the pooled analysis, men were more likely to be enrolled in CR compared with women (female enrollment vs male enrollment odds ratio, 0.64; 95% confidence interval, 0.57-0.72; P < 0.00001). Heterogeneity was considered high (I² = 78%). In the subgroup analyses, systematic CR referral during inpatient tertiary care resulted in significantly greater enrollment among women than nonsystematic referral.

Conclusions

Overall, rates of CR enrollment among women are significantly lower compared with men, with women being 36% less likely to enroll in a rehabilitation program.     

Sex and Race Differences in Cardiac Sarcoidosis Presentation,Treatment and Outcomes

BackgroundAlthough sex- and race-based patterns have been described in the extracardiac organ involvement of sarcoidosis, cardiac sarcoidosis (CS)-specific studies are lacking.MethodsWe studied CS presentation, treatment and outcomes based on sex and race in a tertiary-center cohort. Multivariable adjusted Cox proportional hazards and survival analyses were performed for primary composite outcomes (left ventricular assist device, heart transplantation, all-cause death) and for secondary outcomes (ventricular arrhythmia and all-cause death.ResultsWe identified 252 patients with CS (108 female, 109 Black). At presentation with CS, females vs males (P = 0.001) and Black vs White individuals (P = 0.001) more commonly had symptomatic heart failure (HF), with HF most common in Black females (ANOVA P < 0.001). Treatment differences included more corticosteroid use (90% vs 79%; P = 0.020), higher 1-year prednisone dosage (13 vs 10 mg; P = 0.003) and less frequent early steroid-sparing agent use in males (29% vs 40%; P = 0.05). Black participants more frequently received a steroid-sparing agent (75% vs 60%; P = 0.023). Composite outcome-free survival did not differ by sex or race. Male sex had an adjusted hazard ratio of 2.34 (95% CI 1.13, 4.80; P = 0.021) for ventricular arrhythmia.ConclusionCS course may differ by sex and race and may contribute to distinct clinical CS phenotypes.