Gender Differences in Autonomic Modulation of Ventricular Repolarization in Humans

• Published in: Journal of cardiovascular electrophysiology Vol. 16; no. 3; pp. 278 - 284
• Main Authors: NAKAGAWA, MIKIKO, OOIE, TATSUHIKO, OU, BAIQING, ICHINOSE, MASASHI, TAKAHASHI, NAOHIKO, HARA, MASAHIDE, YONEMOCHI, HIDETOSHI, SAIKAWA, TETSUNORI
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK Blackwell Science Inc 01.03.2005
• Subjects: Adult; Atropine - pharmacology; autonomic blockade; Autonomic Nervous System - drug effects; Disease Susceptibility; Electrophysiologic Techniques, Cardiac; Female; gender difference; Humans; isoproterenol; Isoproterenol - administration & dosage; Long QT Syndrome - chemically induced; Long QT Syndrome - genetics; Long QT Syndrome - physiopathology; Male; Propranolol - pharmacology; QT interval; Receptors, Adrenergic, beta - drug effects; Risk Factors; Sex Factors; T wave; Torsades de Pointes - chemically induced; Torsades de Pointes - genetics; Torsades de Pointes - physiopathology; Ventricular Function - drug effects; Ventricular Function - physiology
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1046/j.1540-8167.2005.40455.x

Background: Gender differences in the incidence of ventricular arrhythmias have been reported and torsades de pointes associated with long QT syndrome are more common in women than men. Although increased sympathetic tone has an important role in vulnerability to arrhythmia, little is currently known regarding gender differences in the dynamic electrophysiological response to sympathetic stimulation. Therefore, we investigated whether there is a gender difference in humans with respect to the dynamic response of ventricular repolarization to β‐adrenergic stimulation and to autonomic blockade. Methods: Twelve‐lead ECGs were continuously recorded during isoproterenol infusion (protocol 1) and autonomic blockade with propranolol and atropine infusion (protocol 2) in 24 healthy volunteers (12 men, 23 ± 2 years; 12 women, 23 ± 5 years). QT (QTc) intervals were measured at the baseline and at a heart rate of 75, 100, and 120 beats/min. Results: (1) The morphology of the T wave dynamically and transiently changed to bifid or biphasic during the acute phase of isoproterenol infusion. The incidence of these morphologic changes was higher in women than men (P < 0.05). (2) The QTc interval was initially prolonged and then shortened in both men and women during isoproterenol administration. However, QTc prolongation was significantly greater in women (0.44 ± 0.02 to 0.55 ± 0.03 sec) than men (0.42 ± 0.03 to 0.51 ± 0.04 sec; P < 0.05). (3) The QTc interval was significantly prolonged under autonomic blockade and the intrinsic QTc interval was longer in women than men (P < 0.05). Conclusion: While sympathetic stimulation and autonomic blockade modulated the dynamics of ventricular repolarization in both sexes, it was more pronounced in women. This gender difference may partially account for the susceptibility of women to arrhythmogenesis.