Gender Differences in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion.

BACKGROUND: Current recommendations on the rhythm control strategy for treatment of atrial fibrillation (AF) are more restrictive than a decade ago. Gender may play a role in decisions on the management of AF, including application of electrical cardioversion. METHODS: We analyzed clinical characteristics by gender in patients participating in the observational survey about stable patients underlying cardioversion in Spain (CARDIOVERSE) study (n=915), a survey of the practice of electrical cardioversion in 67 Spanish hospitals. We compared these data with those from a previous survey of electrical cardioversion in Spain (REVERSE study) performed 8 years previously. RESULTS: Patients undergoing electrical cardioversion were mainly men (76%). This finding was observed in all age groups, independently of symptoms. Men were younger (62±10 years vs. 69±9 years; p<0.001), more frequently asymptomatic and had a lower prevalence of hypertension and a lower stroke risk. Among asymptomatic patients, the predominance of men was especially evident in older age groups (<65 years, men 76%, women 24%; ≥65 years, men 92%, women 8% (p<0.001). Compared with the REVERSE study, we observed a decrease in the percentage of women among patients undergoing electrical cardioversion (37% REVERSE vs. 24% CARDIOVERSE; p<0.001), mainly in older than 65 years. CONCLUSIONS: Our results support the hypothesis that gender is a determinant in decisions on the most appropriate strategy for managing AF. We observed a decrease in the percentage of women undergoing electrical cardioversion during the last decade, especially in older asymptomatic patients.

Reproducibility of electrocardiographic findings in patients with suspected reflex neurally-mediated syncope.

The reproducibility of electrocardiographic (ECG) recordings in syncopal recurrences and the diagnostic role of nonsyncopal arrhythmias are not well known. The objective of this study was to analyse the reproducibility of the ECG findings recorded with implantable loop recorders in 41 patients with suspected neurally-mediated syncope who were included in the International Study on Syncope of Uncertain Origin-2 study and that had > or =2 events recorded by implantable loop recorders. In these patients, the electrocardiogram obtained with the first documented syncope (index syncope) was compared with other recorded events. Twenty-two patients had > or =2 syncopes, and their electrocardiograms were reproducible in 21 (95%): 15 with sinus rhythm, 5 with asystole, and 1 with ventricular tachycardia; 1 had asystole at first syncope and sinus rhythm at recurrent syncope. In 32 patients with nonsyncopal episodes, an arrhythmia was documented in 9, and all of them had the same arrhythmia during the index syncope (100% reproducibility); conversely, when sinus rhythm was documented (23 patients) during nonsyncopal episodes, an arrhythmia was still documented in 6 during the index syncope (70% reproducibility; p = 0.0004). In conclusion, the ECG findings during the first syncope are highly reproducible in subsequent syncopes. The presence of an arrhythmia during nonsyncopal episodes is also highly predictive of the mechanism of syncope, but the presence of sinus rhythm does not rule out the possibility of arrhythmia during syncope. Therefore the finding of an arrhythmia during a nonsyncopal episode allows the etiologic diagnosis of syncope, and eventually to anticipate treatment, without waiting for syncope.