Gender differences in the electrophysiological characteristics of atrioventricular conduction system and their clinical implications

Abstract

Objective.-The underlying mechanisms of the differences in sex distribution of patients with atrioventricular (AV) nodal re-entrant tachycardia and Wolff-Parkinson-White syndrome are poorly understood. The objective of this study was to determine potential gender differences in the electrophysiological properties of the normal AV conduction system that may be attributable to differences in sex distribution. Design.-The AV conduction properties were studied in 96 patients (52 men and 44 women) who underwent electrophysiological testing, 32 patients with atrial tachycardia, 39 with idiopathic ventricular tachycardia and 25 with unexplained palpitations or syncope. Results.-The AH (83 ± 15 ms) and His-ventricular intervals in men (42 ± 6 ms) were significantly longer than in women (78 ± 14, 38 ± 6 ms, p < 0.05, respectively), as was the PR interval (160 ± 17 vs 152 ± 13 ms, p = 0.02). The effective refractory period of AV node in men (349 ± 75 ms) was longer than in women (297 ± 45 ms, p = 0.03). However, no significant difference was observed between men and women with respect to the incidence of AV nodal dual pathway and the maximum AH interval achieved during premature stimulation or incremental pacing. The AV block cycle length was significantly longer in men (371 ± 76 ms) than in women (330 ± 52 ms, p = 0.02). A longer ventriculoatrial block cycle length was also found in men than in women although not at a significant level (436 ± 107 vs 384 ± 90 ms, p = 0.08). In addition, men (23%) were twice as likely to have ventriculoatrial dissociation during ventricular pacing as women were (11%, p = 0.2). Conclusion.-The data show that gender-related differences in AV conduction properties may be responsible for the differences in sex distribution observed in patients with AV nodal re-entrant tachycardia and those with ventricular pre-excitation.