Gender associated disparities in atrioventricular nodal reentrant tachycardia: A review article

An observational study on efficacy of atrioventricular nodal slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia and its influence on atrioventricular conduction function

The study aimed to evaluate the effectiveness of atrioventricular nodal slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia (AVNRT) and examine its impact on the atrioventricular conduction function. A retrospective analysis was performed on the clinical data of 90 AVNRT patients who underwent radiofrequency ablation at our institution between August 2018 and February 2021. Based on the presence or absence of slow pathway conduction during the procedure, patients were classified into the slow pathway elimination group (SPE group) and the slow pathway improvement group (SPI group). Procedure-related parameters, His bundle electrogram, atrioventricular nodal effective refractory period (AVN-ERP), Wenckebach point of anterograde atrioventricular nodal conduction (AVN-WKB), Wenckebach point of retrograde atrioventricular nodal conduction (VAV-WKB), myocardial function were compared between the 2 groups. Additionally, the recurrence rates 1 and 2 years post-ablation were noted. Both groups reported a 100% success rate for the procedure. Post-ablation, 42 patients exhibited persisting atrioventricular nodal slow pathway, whereas 48 showed its disappearance, signifying the absence of the jump phenomenon and atrial echo. Post-ablation, the SPI group showed an increase in slow pathway AVN-ERP compared to pre-ablation values (P < .05), with no significant change in the fast pathway AVN-ERP (P > .05). The SPE group showed a reduction in both slow pathway and fast pathway AVN-ERP post-ablation (P < .05). Post-ablation, both slow pathway and fast pathway AVN-ERP in the SPI group were higher than in the SPE group (P < .05). AVN-WKB and VAV-WKB values increased in both groups after ablation (P < .05). There were no recurrences 1 or 2 years after ablation in the SPE group and 1 case of recurrence 2 years after ablation in the SPI group (2.38%). Different ablation endpoints during radiofrequency ablation had no apparent impact on atrioventricular conduction time, recurrence rate, and myocardial function in patients with AVNRT, but they advanced AVN-WKB and VAV-WKB. Slow pathway improvement led to an elongation of slow pathway AVN-ERP, while slow pathway elimination resulted in a reduction of both slow pathway and fast pathway AVN-ERP.

Sex-Specific Differences in Cardiovascular Adaptations and Risks in Elite Athletes: Bridging the Gap in Sports Cardiology

BACKGROUND

The growing participation of women in competitive sports necessitates a comprehensive understanding of sex-specific cardiovascular adaptations and risks. Historically, research has predominantly focused on male athletes, leaving a gap in knowledge about the unique cardiovascular dynamics of female peers.

HYPOTHESIS

we hypothesized that female athletes exhibit distinct cardiovascular adaptations and face different risks, influenced by physiological, hormonal, and structural differences.

METHODS

A systematic review of the literature was conducted, analyzing studies on cardiovascular responses and adaptations in athletes. Data were extracted on hemodynamic changes, autonomic and neural reflex regulation, cardiac remodeling, and arrhythmias. Comparative analyses were performed to identify sex-specific patterns and discrepancies in cardiovascular health outcomes.

RESULTS

We revealed considerable sex differences in cardiovascular adaptations to athletic training. Female athletes generally have longer QT intervals, greater sinoatrial node automaticity, and enhanced atrioventricular node function compared to males. They also exhibit lower sympathetic activity, lower maximal stroke volumes, and a tendency toward eccentric cardiac remodeling. Conversely, male athletes are more prone to concentric hypertrophy and higher incidences of bradyarrhythmia and accessory pathway arrhythmias. Female athletes are more likely to experience symptomatic atrial fibrillation and face higher procedural complications during catheter ablation.

CONCLUSIONS

Our findings underscore the necessity for sex-specific approaches in sports cardiology. Recognizing and addressing these differences could enhance performance and reduce adverse cardiac events in athletes. Future research should focus on developing tailored screening, prevention, and treatment strategies to bridge the knowledge gap and promote cardiovascular health in both male and female athletes.

Gender and race-related disparities in the management of ventricular arrhythmias

Modern studies have revealed gender and race-related disparities in the management and outcomes of cardiac arrhythmias, but few studies have focused on outcomes for ventricular arrhythmias (VAs) such as ventricular tachycardia (VT) or ventricular fibrillation (VF). The aim of this article is to review relevant studies and identify outcome differences in the management of VA among Black and female patients. We found that female patients typically present younger for VA, are more likely to have recurrent VA after catheter ablation, are less likely to be prescribed antiarrhythmic medication, and are less likely to receive primary prevention ICD placement as compared to male patients. Additionally, female patients appear to derive similar overall mortality benefit from primary prevention ICD placement as compared to male patients, but they may have an increased risk of acute post-procedural complications. We also found that Black patients presenting with VA are less likely to undergo catheter ablation, receive appropriate primary prevention ICD placement, and have significantly higher risk-adjusted 1-year mortality rates after hospital discharge as compared to White patients. Black female patients appear to have the worst outcomes out of any demographic subgroup.

Review: Sex-related differences in the treatment of cardiac arrhythmia

Cardiac arrhythmias are a common and potentially serious cardiovascular disorders that affect both men and women. However, there is evidence to suggest that there may be sex-related differences in the prevalence, clinical presentation, and management of cardiac arrhythmias. Hormonal and cellular factors may play a role in these sex-specific differences. In addition, there are differences in the types of arrhythmias that men and women experience, with men more likely to experience ventricular arrhythmias and women more likely to experience supraventricular arrhythmias. The management of cardiac arrhythmias also differs between men and women. For example, some studies have found that women are less likely to receive appropriate treatment for arrhythmias and are more likely to have adverse outcomes following treatment. Despite these sex-related differences, the majority of research on cardiac arrhythmias has been conducted in men, and there is a need for more research to specifically examine the differences between men and women. This is especially important given that the prevalence of cardiac arrhythmia is increasing, and it is essential to understand how to effectively diagnose and treat these conditions in both men and women. In this review, we examine the current understanding of sex-related differences in cardiac arrhythmias. We also review the available data on sex-specific management strategies for cardiac arrhythmias and highlight areas of future research.

Sex and racial disparities in catheter ablation

Sex and racial disparities in the presentation, diagnosis, and management of cardiac arrhythmias are recognized. Sex-specific differences in electrophysiological parameters are well known and are predominantly related to differences in ion channel expression and the influence of sex hormones. However, the relationship between hormonal or racial influence and arrhythmia mechanisms, presentation, and management needs to be better defined. Women and racial and ethnic groups are less likely to undergo catheter ablation procedures for treatment of cardiac arrhythmias. Underrepresentation of women and racial/ethnic groups in clinical trials has resulted in significant knowledge gaps. Whether sex and racial disparities in arrhythmia management reflect barriers in access to care, physician bias, patient values, and preferences or other factors requires further study.