Abstrait

Atrial fibrillation in women

Michael Kuhne and David Conen

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice both in women and men, and is associated with an important socioeconomic burden. Epidemiological data predict an increase in AF prevalence by a factor of two to three in the next few decades. The purpose of this article is to provide insight into the epidemiology of AF in women, to describe the risk factors associated with AF in women, and to focus on the implications of female gender on the presentation and management of AF. The prevalence of AF varies widely between different age groups in both women and men. However, in every age group, AF is less frequent in women than in men. The risk of AF associated with blood pressure, obesity or structural heart disease is similar in women and men. However, the different prevalence across genders leads to differing attributable risk estimates for these risk factors. Women are more symptomatic when AF occurs and episodes are often associated with higher heart rates. Women with AF also appear to have a lower quality of life compared with men, and are more likely to develop stroke and have more resulting disabilities and a lower quality of life after having suffered from a stroke. Oral anticoagulants are used less frequently in women, although women seem to benefit more from the treatment compared with men. This is possibly due to the increased risk of hemorrhage in women. Women are referred to interventional therapies (e.g., catheter ablation) later during the course of the disease and with a more complex clinical presentation. More studies are required to provide further insights into the gender-specific pathophysiology of AF in order to find potential targets for future AF therapies, and improve AF prevention in both women and men.