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Europace. 2019 Mar 1;21(3):366-376. doi: 10.1093/europace/euy215.

Mechanisms of sex differences in atrial fibrillation: role of hormones and differences in electrophysiology, structure, function, and remodelling.

Author information

1
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.
2
Faculty of Medicine, University of Freiburg, Freiburg, Germany.
3
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands.
4
Asklepios Medical Center Altona, Department of Cardiology, Arrhythmia Unit, Hamburg, Germany.
5
Hartcentrum Hasselt, Jessa Ziekenhuis Hasselt, Hasselt, Belgium.
6
Department of Surgical and Interventional Arrhythmology, Kuprianov's Cardiovascular Surgery Clinic, Military Medical Academy, St. Petersburg, Russia.
7
Rhythmology Division, Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland.
8
Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich-Schlieren, Switzerland.
9
Heart Center, University of Leipzig, Leipzig, Germany.
10
Massachusetts General Hospital, Harvard University, Boston, MA, USA.
11
National Heart & Lung Institute, Imperial College London, London, UK.
12
Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
13
Fundacion Jimenez Diaz - Quiron Salud, Madrid, Spain.
14
Department of Cardiology, Radboud University Medical Center, GA Nijmegen, The Netherlands.
15
Department of Cardiology, Leiden University Medical Center, ZA Leiden, The Netherlands.
16
Department of Cardiology, Electrophysiology Unit, Hacettepe University, Ankara, Turkey.

Abstract

Atrial fibrillation (AF) is the clinically most prevalent rhythm disorder with large impact on quality of life and increased risk for hospitalizations and mortality in both men and women. In recent years, knowledge regarding epidemiology, risk factors, and patho-physiological mechanisms of AF has greatly increased. Sex differences have been identified in the prevalence, clinical presentation, associated comorbidities, and therapy outcomes of AF. Although it is known that age-related prevalence of AF is lower in women than in men, women have worse and often atypical symptoms and worse quality of life as well as a higher risk for adverse events such as stroke and death associated with AF. In this review, we evaluate what is known about sex differences in AF mechanisms-covering structural, electrophysiological, and hormonal factors-and underscore areas of knowledge gaps for future studies. Increasing our understanding of mechanisms accounting for these sex differences in AF is important both for prognostic purposes and the optimization of (targeted, mechanism-based, and sex-specific) therapeutic approaches.

KEYWORDS:

Atrial fibrillation; Electrophysiology; Estrogen; Mechanisms; Sex differences; Sex hormones; Structural remodelling

PMID:
30351414
DOI:
10.1093/europace/euy215
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