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Costa S, Saguner AM, Gasperetti A, Akdis D, Brunckhorst C, Duru F. The Link Between Sex Hormones and Susceptibility to Cardiac Arrhythmias: From Molecular Basis to Clinical Implications. Front Cardiovasc Med 2021; 8:644279. [PMID: 33681311 PMCID: PMC7925388 DOI: 10.3389/fcvm.2021.644279] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/27/2021] [Indexed: 12/30/2022] Open
Abstract
It is well-known that gender is an independent risk factor for some types of cardiac arrhythmias. For example, males have a greater prevalence of atrial fibrillation and the Brugada Syndrome. In contrast, females are at increased risk for the Long QT Syndrome. However, the underlying mechanisms of these gender differences have not been fully identified. Recently, there has been accumulating evidence indicating that sex hormones may have a significant impact on the cardiac rhythm. In this review, we describe in-depth the molecular interactions between sex hormones and the cardiac ion channels, as well as the clinical implications of these interactions on the cardiac conduction system, in order to understand the link between these hormones and the susceptibility to arrhythmias.
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Affiliation(s)
- Sarah Costa
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Ardan M Saguner
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Alessio Gasperetti
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, Zurich, Switzerland.,Cardiac Arrhythmia Service, Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Deniz Akdis
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Corinna Brunckhorst
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Okajima T, Imai H, Murase Y, Ogawa Y, Kawaguchi K. The efficacy of radiofrequency catheter ablation for menstruation-dependent incessant ventricular tachycardia: A case report. HeartRhythm Case Rep 2019; 6:158-162. [PMID: 32181136 PMCID: PMC7064799 DOI: 10.1016/j.hrcr.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | | | - Yosuke Murase
- Address reprint requests and correspondence: Dr Yosuke Murase, Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan.
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Wamboldt R, Haseeb S, Waddington A, Baranchuk A. Cardiac arrhythmias secondary to hormone therapy in trans women. Expert Rev Cardiovasc Ther 2019; 17:335-343. [PMID: 30987471 DOI: 10.1080/14779072.2019.1606713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: With greater social acceptance and the evolution of transgender medicine as a specialty, more trans women are seeking hormone therapy (HT). Several studies have identified an increase in cardiovascular disease in trans women, however no studies have investigated the incidence of arrhythmias. Using two cases from the authors' clinic as examples, we propose that hormone therapy in trans women may increase the risk of cardiac arrhythmias. Areas covered: A literature search of sex hormones and cardiac arrhythmias was conducted. Using sex hormone studies completed in cis individuals and animal models we identified several similarities to trans women on HT. In cis men, low levels of testosterone are associated with increased rates of atrial fibrillation and right ventricular outflow tract arrhythmias. The role of estradiol remains less clear but there is evidence to suggest that the administration of exogenous estrogen may increase the rates of cardiac arrhythmias in cis women. Expert opinion: Research in the field of transgender medicine is expanding. As more trans women initiate HT, we will have a larger database from which to collect information regarding the benefits and risks of treatment, including the potential side effect of arrhythmias.
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Affiliation(s)
- Rachel Wamboldt
- a Division of Internal Medicine, Kingston Health Science Center , Queen's University , Kingston , Ontario , Canada
| | - Sohaib Haseeb
- b Division of Cardiology, Kingston Health Science Center , Queen's University , Kingston , Ontario , Canada
| | - Ashley Waddington
- c Department of Obstetrics & Gynecology, Kingston Health Science Center , Queen's University , Kingston , Ontario , Canada
| | - Adrian Baranchuk
- b Division of Cardiology, Kingston Health Science Center , Queen's University , Kingston , Ontario , Canada
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Akdis D, Saguner AM, Shah K, Wei C, Medeiros-Domingo A, von Eckardstein A, Lüscher TF, Brunckhorst C, Chen HSV, Duru F. Sex hormones affect outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia: from a stem cell derived cardiomyocyte-based model to clinical biomarkers of disease outcome. Eur Heart J 2018; 38:1498-1508. [PMID: 28329361 DOI: 10.1093/eurheartj/ehx011] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/10/2017] [Indexed: 12/11/2022] Open
Abstract
Aims Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is characterized by fibrofatty infiltration of the myocardium and ventricular arrhythmias that may lead to sudden cardiac death. It has been observed that male patients develop the disease earlier and present with more severe phenotypes as compared to females. Thus, we hypothesized that serum levels of sex hormones may contribute to major arrhythmic cardiovascular events (MACE) in patients with ARVC/D. Methods and results The serum levels of five sex hormones, sex hormone-binding globulin, high sensitivity troponin T, pro-brain natriuretic peptide, cholesterol, triglycerides, insulin, and glucose were measured in 54 ARVC/D patients (72% male). Twenty-six patients (48%) experienced MACE. Total and free testosterone levels were significantly increased in males with MACE as compared to males with a favourable outcome, whereas estradiol was significantly lower in females with MACE as compared to females with a favourable outcome. Increased testosterone levels remained independently associated with MACE in males after adjusting for age, body mass index, Task Force criteria, ventricular function, and desmosomal mutation status. Furthermore, an induced pluripotent stem cell-derived ARVC/D cardiomyocyte model was used to investigate the effects of sex hormones. In this model, testosterone worsened and estradiol improved ARVC/D-related pathologies such as cardiomyocyte apoptosis and lipogenesis, strongly supporting our clinical findings. Conclusions Elevated serum testosterone levels in males and decreased estradiol levels in females are independently associated with MACE in ARVC/D, and directly influence disease pathology. Therefore, determining the levels of sex hormones may be useful for risk stratification and may open a new window for preventive interventions.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Khooshbu Shah
- Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute, 10901 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Chuanyu Wei
- Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute, 10901 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | | | - Arnold von Eckardstein
- Department of Clinical Chemistry, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Winterthurerstr 190, 8057 Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Winterthurerstr 190, 8057 Zurich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - H S Vincent Chen
- Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute, 10901 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Winterthurerstr 190, 8057 Zurich, Switzerland
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Jiang H, Hu X, Wang J. Estrogen replacement therapy for idiopathic outflow tract ventricular arrhythmias: a potential therapeutic approach. Med Hypotheses 2011; 78:144-5. [PMID: 22047984 DOI: 10.1016/j.mehy.2011.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 10/11/2011] [Indexed: 11/26/2022]
Abstract
Idiopathic outflow tract ventricular arrhythmias (IOTVA), including left and right ventricular outflow tract, are dued to cyclic adenosine monophosphate (cAMP)-mediated calcium-dependent delayed after depolarizations. A growing body of evidence suggests that the changes of sex hormone levels and gender differences may affect ventricular repolarization and be associated with the occurrence of ventricular arrhythmias. Recent studies showed that the level of estradiol in the IOTVA male patients decreased significantly and the count of ventricular arrhythmias was significantly negatively correlated with the level of estradiol in male patients with IOTVA. Meanwhile, estrogen replacement therapy could inhibit significantly the count of ventricular arrhythmias in the postmenopausal patients with IOTVA. In conclusion, estrogen replacement therapy may be a potential therapeutic approach for IOTVA besides postmenopausal patients.
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Affiliation(s)
- Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, China.
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Hu X, Wang J, Xu C, He B, Lu Z, Jiang H. Effect of oestrogen replacement therapy on idiopathic outflow tract ventricular arrhythmias in postmenopausal women. Arch Cardiovasc Dis 2011; 104:84-8. [DOI: 10.1016/j.acvd.2010.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/21/2010] [Accepted: 11/24/2010] [Indexed: 11/30/2022]
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