Sex differences in cardiac electrophysiology and clinical arrhythmias: epidemiology, therapeutics, and mechanisms

Can J Cardiol. 2014 Jul;30(7):783-92. doi: 10.1016/j.cjca.2014.03.032. Epub 2014 Mar 28.


Sex differences in cardiac electrophysiological properties and arrhythmias are evident in epidemiologic and investigative studies as well as in daily patient care. At the supraventricular level, women are at increased risk of sick sinus syndrome and atrioventricular (AV) node re-entrant tachycardia, whereas men manifest more AV block and accessory pathway-mediated arrhythmias. At the ventricular level, women are generally at higher risk of long QT-associated arrhythmias, whereas men are more likely to present with early repolarization, idiopathic ventricular fibrillation, and Brugada syndromes. Great advances have been made in unraveling the fundamental mechanisms underlying sex differences in ventricular arrhythmias, particularly those associated with abnormal repolarization. Conversely, the basis for male-predominant arrhythmia risk in structural heart disease and differences in supraventricular arrhythmia susceptibility are poorly understood. Beyond biological differences, arrhythmia occurrence and patient care decisions are also influenced by gender-related factors. This article reviews the current knowledge regarding the nature and underlying mechanisms of sex differences in basic cardiac electrophysiology and clinical arrhythmias.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use*
  • Arrhythmias, Cardiac* / epidemiology
  • Arrhythmias, Cardiac* / physiopathology
  • Arrhythmias, Cardiac* / therapy
  • Bundle of His / physiopathology*
  • Cardiac Resynchronization Therapy / methods*
  • Electrophysiologic Techniques, Cardiac*
  • Female
  • Global Health
  • Heart Rate / physiology*
  • Humans
  • Male
  • Morbidity / trends
  • Risk Assessment*
  • Risk Factors
  • Sex Factors


  • Anti-Arrhythmia Agents