Sex Difference in Catheter Ablation of Idiopathic Ventricular Arrhythmias and Ventricular Arrhythmias Associated with Structural Heart Disease

Abstract

Sex differences in clinical manifestations, electrophysiological properties and treatment of ventricular arrhythmias (VA) have been an area of research in the last years. In this review, we focus on sex differences in the catheter ablation of VA in patients with and without structural heart disease. Women have more frequently RVOT than LVOT PVC/VTs but intrafascicular re-entry occurs more frequently in men than in women. Sex-dependent differences in the autonomic nervous system, hormonal status and/or arrhythmogenic characteristics of the substrate may explain these differences. Women are severely underrepresented in studies of catheter ablation of VA in patients with structural heart disease. This may be explained by the fact that women have lower incidence of certain structural heart diseases (as coronary artery disease and ARVC) and lower susceptibility to ventricular arrhythmias and arrhythmic sudden cardiac death. Catheter ablation of VT in women with coronary artery disease may be associated with slightly higher VT recurrence and same complication rate as in male patients. In women with non-ischemic cardiomyopathy and ARVC catheter ablation are equally effective. In summary, all studies up to date reported that catheter ablation of idiopathic ventricular arrhythmias is equally effective with the same risk of complications in both sex groups. Women with structural heart disease show lower susceptibility to ventricular arrhythmias and arrhythmic sudden cardiac death. Catheter ablation of VT in ischemic heart disease is slightly less effective in women, but is equally effective in NICM and ARVC as in men.