Gender in atrial fibrillation: Ten years later

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in both male and female patients. Objective: This evidence-based update attempts to address the advances in the science of AF management in light of key gender issues. Methods: In October 2009, 2 investigators (H.I.M. and B.D.P.) independently searched MEDLINE (PubMed [19502009] and Ovid [20002009]) for all publication types in the English language, using database-specific controlled vocabulary describing the concepts of AF and gender (atrial fibrillation, gender, women, and men for PubMed; atrial fibrillation and gender for Ovid). The reference sections from the identified publications were also used. The methodologic quality of publications, their content relevance, and the authors' expert opinions guided publication inclusion in this evidence-based narrative review. Articles relevant to gender differences in pathophysiology, outcomes, and treatment of AF are summarized and discussed. Results: Based on current available data, mortality is greater for women with AF than for men with AF. Women with AF have a higher risk of stroke compared with their male counterparts. Women derive the greatest benefit from anticoagulation in AF. There are no significant sex differences in major bleeding risk from warfarin. Women tend to be more symptomatic from AF than are men, but fare worse than men when a rhythm-control strategy is utilized with antiarrhythmic medications. Women have an increased risk for torsades de pointes when taking sotalol or dofetilide, and have a higher risk of bradyarrhythmias when taking antiarrhythmics. AF catheter ablation is successful and beneficial for selected patients of both sexes, although women may incur higher procedural bleeding complications. Women tend to be referred for AF ablation less and later than are men. Conclusions: The past decade has witnessed significant progress in the understanding and management of AF. Awareness of key sex-specific differences in AF allows for a more safe, effective, and personalized approach to the management of this disorder.