More reasons why men and women are not the same (gender differences in electrophysiology and arrhythmias).

It has become increasingly apparent in recent years that there are important differences in the presentation and clinical course of many cardiovascular disorders in men and women. These gender differences extend to clinical cardiac electrophysiology, with respect to basic electrophysiology as well as the presentation and clinical courses of many arrhythmias. Women have been noted to have higher heart rates at rest and longer corrected QT intervals compared with men. Differences in gender hormones may explain some of these findings, but precisely how is still not well understood. Differences have also been documented in the incidence and prevalence of specific arrhythmias, including atrial fibrillation, other supraventricular tachycardias, and sudden cardiac death. Variations in arrhythmia frequency with respect to the menstrual cycle have been observed. In addition, an increase in arrhythmia frequency or the new onset of arrhythmias has been noted during pregnancy. With the increasing use of implantable cardioverter defibrillators and cardiac resynchronization therapy, it has been shown that men and women derive equal survival and symptom reduction benefit. However, it has been found that the use of these devices in women is much lower than would be expected from the prevalence of disease in the population. The reasons for this lower utilization rate are not well understood and remain to be explored. In conclusion, the goal of this review is to summarize the currently available published reports regarding gender differences in cardiac electrophysiology and arrhythmias and to provide an update from recent studies.

Non-antiarrhythmic medications for atrial fibrillation: from bench to clinical practice.

Many treatment modalities have been developed over the years for the management of atrial fibrillation (AF). While they are still considered the first line of treatment for suppression of AF, antiarrhythmics often lead to treatment failure, complications and undesired consequences. Pulmonary vein ablation is an invasive procedure which is not always curative. Recently, there have been a variety of studies reporting the potential antiarrhythmic effects of various nonantiarrhythmic agents. This paper aims to provide a comprehensive review of the findings reported thus far about the antiarrhythmic effects of agents which are not antiarrhythmic drugs themselves, but which have been found to offer promise in the prevention and treatment of AF.

Why cardioverter-defibrillator implantation might not be the best idea for your elderly patient.

Over the last decade, implantable cardioverter-defibrillators (ICDs) have become a part of mainstream clinical practice, with improvements in survival in a broad range of patients. Given the overall limited life expectancy of elderly patients, their frequent comorbidities, and the complications associated with ICD implantation, it may not be reasonable to expect results with ICD implantation in the elderly to be comparable to that found in the clinical trials. In this paper, the authors review the available scientific literature and discuss why mainstream ICD use in the elderly may not be advisable.

Sex-based differences in cardiac resynchronization therapy and implantable cardioverter defibrillator therapies: effectiveness and use.

With the rapid advancements in heart failure device therapy, many physicians now use these devices in everyday clinical practice. However, questions remain regarding the clinical benefit of these therapies in different patient subgroups. Since the majority of patients enrolled in device trials are white men, extrapolating the data to specific patient subpopulations becomes important. Specifically, the question of clinical outcomes in women with implantable device therapy for prevention of sudden cardiac death and management of heart failure is an important clinical issue. In this article, we review the data on survival and clinical outcomes with heart failure device therapy (implantable cardioverter defibrillators [ICDs] and cardiac resynchronization therapy [CRT]) and analyze the results from clinical trials for any differences in outcomes based on gender. Even though women are a significantly under-represented population with regard to clinical investigation and utilization of heart failure devices, they still derive the same morbidity and mortality benefits compared to men. Specifically, ICD devices confer the same rates of sudden cardiac death prevention, and CRT devices improve CHF morbidity and mortality at rates comparable to those found in men. These results support equal use of ICDs and CRT in men and women.