Arrythmias in Women: Diagnosis and Management
Sex differences in arrhythmias is not a new concept. Yet rarely do you see it mentioned in textbooks—even the comprehensive electrophysiology ones. A book devoted to this subject is certainly needed. In the foreword of Arrhythmias in Women: Diagnosis and Management, Sharonne Hayes points out that until recently there was a paucity of data to help physicians make clinical decisions when treating women with arrhythmias. More recently, sex-specific, evidence-based information has become available as a result of research initiatives. The purpose of this book is to get the message out, and it has succeeded in that regard. The editors are Yong-Mei Cha and Margaret Lloyd from Mayo Clinic, as well as Ulrika Birgersdotter-Green from UC San Diego. The authors are all women, with the exception of one. They are all leaders in the field of electrophysiology and have themselves made significant contributions to our knowledge of sex-based arrhythmia differences.
Arrhythmias in Women is an easily readable and concise text, consisting of 15 chapters in 257 pages. The focus is on sex differences and how they impact the diagnosis and management of arrhythmias in women. In their preface to the book, the editors state that this text is not meant to encompass all aspects of electrophysiology. In place of a referenced text, there is simply a list of suggested reading at the end of each chapter. There are an appropriate number of tables and figures, and the figures are in color.
The first chapter discusses whether there is “sex bias or sex disparities” in the treatment of arrhythmias in women. The author, Jodie Hurwitz, answers the question, and provides a useful summary table, listing sex differences in clinical outcomes for ablation and device procedures. The next chapter is on the topic of women in clinical trials. Jeanne Poole, the author, describes the government’s initiative, through the National Institutes of Health, to include women in clinical trials. Although the percentage of women in studies continues to be low, some useful data have been obtained. This chapter has a detailed table of device and antiarrhythmic drug clinical trial results, with the percentage of women in each trial and results of the female subpopulation, if available. The chapter ends with a discussion of how to possibly improve the enrollment of women in clinical trials, to allow better detection of sex differences in therapies.
Arrhythmias in Women covers all the expected topics, including sex differences in electrophysiological properties, atrial arrhythmias, long QT syndrome, and proarrhythmia with antiarrhythmic drugs. These chapters are all written by well-known electrophysiologists. There is also a chapter on pregnancy and arrhythmias which includes a useful table of antiarrhythmic drugs and their safety rating during pregnancy and breast feeding. There are some general guidelines provided on anticoagulation during pregnancy, and a short section regarding the diagnosis and treatment of fetal arrhythmias. The author, Lynda Rosenfeld, is also trained in pediatrics, which gives her a broader perspective of the topic.
Additional chapters in the book show us that there are sex differences in all areas of arrhythmia management. Women are particularly prone to orthostatic intolerance; medical management of their symptoms can be challenging. I found Celina Yong and Karen Friday’s chapter on syncope and postural orthostatic tachycardia syndrome to be very well organized. It provides helpful information, even for those who feel they are experts on the subject. The authors describe the different mechanisms of orthostatic intolerance, and provide therapeutic options for each type. In their chapter on sudden cardiac death, Laura Gravelin and Rachel Lampert point out sex differences in the epidemiology, arrhythmic substrate, and triggers of ventricular arrhythmias. They also discuss the difficulties of risk stratification and risk reduction in women. The chapters on pacing, defibrillator, and resynchronization therapies by Andrea Russo, Judith Mackall, and Yong-Mei Cha contain a number of useful figures and tables. I especially like the table of cardiac resynchronization trials with the percentage of women in each trial and the sex differences in efficacy. This book also includes a chapter by Ulrika Birgersdotter-Green and Margaret Lloyd on lead extraction as it relates to women. A discussion on genetic differences of arrhythmias in women has not been left out. In Ohad Ziv and Elizabeth Kaufman’s chapter on this subject, there is an informative discussion on the appropriate use of genetic testing.
This book has a couple of unexpected bonus chapters. One focuses on ethnic differences in women around the world. In their summary, Uma Srivatsa and Amparo Villablanca offer suggestions for possible research opportunities. I found the chapter on the development of the first women’s heart clinic surprisingly interesting. Darcy Theisen and Bobbi Hoppe have written about their experience, which makes for an excellent blueprint for any group who wants to start their own successful clinic. Anyone who reads this chapter will be inspired and motivated to make changes in their practice site.
Although there have been books devoted to heart disease in women, none before Arrhythmias in Women has covered electrophysiology exclusively. The authors and editors have succeeded in presenting the data in an easily digestible fashion, and have covered the important issues and barriers relating to the treatment of arrhythmias in women. I recommend this book as a good resource not only for electrophysiologists, but for any physician or health professional caring for women with arrhythmias. It does not cover the basic concepts of electrophysiology, but it does offer a sex-based approach to arrhythmia management. It is written in such a way that it can be understood by professionals of differing backgrounds. Anyone interested in clinical research in this area could certainly find ideas for projects by reading this book. The text also proposes challenges for the future and helps us consider a more personalized approach to therapy for our female patients.
Deborah L. Wolbrette, MD
Penn State Milton S. Hershey Medical Center
Penn State University College of Medicine
- © 2014 American Heart Association, Inc.