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Zeitler EP, Poole JE, Albert CM, Al-Khatib SM, Ali-Ahmed F, Birgersdotter-Green U, Cha YM, Chung MK, Curtis AB, Hurwitz JL, Lampert R, Sandhu RK, Shaik F, Sullivan E, Tamirisa KP, Santos Volgman A, Wright JM, Russo AM. Arrhythmias in Female Patients: Incidence, Presentation and Management. Circ Res 2022; 130:474-495. [PMID: 35175839 DOI: 10.1161/circresaha.121.319893] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.
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Affiliation(s)
- Emily P Zeitler
- The Geisel School of Medicine at Dartmouth, Hanover, NH (E.P.Z.).,Division of Cardiology, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, Lebanon, NH (E.P.Z.)
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle (J.E.P.)
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA (C.M.A., R.K.S.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.-K.)
| | | | | | - Yong-Mei Cha
- Mayo Clinic, St Mary's Campus, Rochester, MN (F.A.-A., Y.-M.C.)
| | | | - Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, NY (A.B.C.)
| | | | - Rachel Lampert
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (R.L.)
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA (C.M.A., R.K.S.)
| | - Fatima Shaik
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ (F.S., A.M.R.)
| | | | | | | | - Jennifer M Wright
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (J.M.W.)
| | - Andrea M Russo
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ (F.S., A.M.R.)
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Fernando H, Adams N, Mitra B. Review article: The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia. Emerg Med Australas 2018; 31:35-42. [PMID: 29752780 DOI: 10.1111/1742-6723.12971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I2 87.3%, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95% confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95% confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14%, haemoglobin 6%, white cell count 19% and chest X-ray 22%. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.
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Affiliation(s)
- Harith Fernando
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Adams
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ferro CRC, de Assis Costa F, Mendonça MA, Rivera I, Ferro FPN, Barbosa JM, Filho ADO, Póvoa R, Cirenza C, de Paola AAV. Correlation of accessory pathway location with gender and their manifest or concealed presentation. Int J Cardiol 2016; 216:43-5. [PMID: 27140335 DOI: 10.1016/j.ijcard.2016.04.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner. OBJECTIVE To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed. METHODS Retrospective observational study including 942 consecutive patients, all diagnosed with EPS-confirmed AP from January 1994 to December 2008. APs were classified into eight anatomical groups: left lateral (LL), left posterior (LP), left posteroseptal (LPS), right posteroseptal (RPS), right midseptal (RMS), right anteroseptal (RAS), right lateral (RL), and right posterior (RP). RESULTS Of the 942 patients, 52.6% were males. The mean age was 31.2±13.8years. As regards gender, APs were more prevalent among men. However, a statistically significant difference was observed only in the LPS (p=0.029) and RL (p=0.003) regions. In relation to the form of presentation of AP, the manifest form was more frequent than the concealed form in six of the eight regions studied, except for the LL and LPS regions. CONCLUSION AP predominated in males and the manifest form was more frequent than the concealed form in most of the regions studied.
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Affiliation(s)
| | | | | | - Ivan Rivera
- Universidade Federal de Alagoas, Universitary Hospital of Alagoas, Brazil
| | | | | | | | - Rui Póvoa
- Universidade Federal de Sao Paulo, Cardiology, Brazil
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Mercuro G, Bassareo PP, Mariucci E, Deidda M, Zedda AM, Bonvicini M. Sex differences in congenital heart defects and genetically induced arrhythmias. J Cardiovasc Med (Hagerstown) 2015; 15:855-63. [PMID: 23422886 DOI: 10.2459/jcm.0b013e32835ec828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sex medicine can be applied to define the effect of male or female sex-associated differences on the prevalence of congenital heart defects (CHDs), on clinical manifestation of the latter, on means of dealing with the defects and facing consequent surgical treatment, as well as on the success of surgery. The widespread use of modern databases has undoubtedly enhanced the possibility of these observations compared to the past, when findings were limited to case series from single cardiology or paediatric heart surgery units. The aim of the present review is to assess all publications present in the literature on sex differences and CHD, placing particular emphasis on both contradictory aspects and less acknowledged issues. Furthermore, a section of the review is devoted to the effect of sex differences on cardiac arrhythmias, particularly the largely genetically predetermined electrophysiological differences observed between men and women.
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Affiliation(s)
- Giuseppe Mercuro
- aDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari bPediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
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Almendral J, Castellanos E, Ortiz M. Taquicardias paroxísticas supraventriculares y síndromes de preexcitación. Rev Esp Cardiol 2012; 65:456-69. [DOI: 10.1016/j.recesp.2011.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 11/27/2011] [Indexed: 10/28/2022]
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Huang SY, Hu YF, Chang SL, Lin YJ, Lo LW, Tuan TC, Lee PC, Li CH, Suenari K, Chao TF, Tai CT, Chiang CE, Chen SA. Gender differences of electrophysiologic characteristics in patients with accessory atrioventricular pathways. Heart Rhythm 2011; 8:571-4. [DOI: 10.1016/j.hrthm.2010.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 12/06/2010] [Indexed: 11/30/2022]
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Medi C, Kalman JM, Freedman SB. Supraventricular tachycardia. Med J Aust 2009; 190:255-60. [DOI: 10.5694/j.1326-5377.2009.tb02388.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 10/02/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Caroline Medi
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC
- Department of Medicine, University of Melbourne, Melbourne, VIC
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC
- Department of Medicine, University of Melbourne, Melbourne, VIC
| | - Saul B Freedman
- Department of Cardiology, Concord Clinical School, Concord Hospital, Sydney, NSW
- Vascular Biology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, NSW
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Porter MJ, Morton JB, Denman R, Lin AC, Tierney S, Santucci PA, Cai JJ, Madsen N, Wilber DJ. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm 2004; 1:393-6. [PMID: 15851189 DOI: 10.1016/j.hrthm.2004.05.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Accepted: 05/14/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to determine the impact of age and gender on the mechanism of paroxysmal supraventricular tachycardia (PSVT). BACKGROUND Previous studies have indicated that PSVT mechanism may be influenced by age and gender, but contemporary data are limited. METHODS In 1,754 patients undergoing catheter ablation of 1,856 PSVTs between 1991 and 2003, the mechanism was classified as atrioventricular reentrant tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), or atrial tachycardia (AT). Patients with inappropriate sinus tachycardia, atrial flutter, atrial fibrillation, and age <5 years were excluded. RESULTS The mean age was 45 +/- 19 years (range 5-96), and the majority were women (62%). Overall, AVNRT was the predominant mechanism (n = 1,042 [56%]), followed by AVRT (n = 500 [27%]) and AT (n = 315 [17%]). There was a strong relationship between age and PSVT mechanism; the proportion of AVRT in both sexes decreased with age, whereas AVNRT and AT increased (PM < .001 by ANOVA). The majority of patients with AVRT were men (273/500 [54.6%]), whereas the majority of patients with AVNRT and AT were women (727/1,042 [70%] and 195/315 [62%], respectively). The distribution of PSVT mechanism was significantly influenced by gender (P < .001). In women, 63% had AVNRT, 20% had AVRT, and 17.0% had AT. In men, 45% had AVNRT, 39% had AVRT, and 17% had AT. AVNRT replaced AVRT as the dominant PSVT mechanism at age 40 in men and at age 10 in women. CONCLUSIONS The mechanism of PSVT in patients presenting for ablation is significantly influenced by both age and gender.
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Affiliation(s)
- Michael J Porter
- Loyola Cardiovascular Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA
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