Atrial Fibrillation in Women: from Epidemiology to Treatment

• Published in: Current cardiovascular risk reports 2022-12, Vol.16 (12), p.207-217
• Main Authors: Tamirisa, Kamala P., Dye, Cicely, Ekeruo, Ijeoma, Volgman, Annabelle Santos
• Format: Article
• Language: English
• Subjects: Cardiology; Gender differences; Hormone replacement therapy; Medicine; Medicine & Public Health; Mortality; Section Editor; Stroke; Topical Collection on Women and Heart Disease; Women and Heart Disease (E. Michos
• ISSN: 1932-9520; 1932-9563
• DOI: 10.1007/s12170-022-00707-w

Purpose of Review Women with atrial fibrillation (AF) have higher risk of strokes and treatment complications. We explored the sex differences in the epidemiology, presentation, and outcomes of AF treatments. Recent Findings Although AF is less prevalent in women, because of their longer life expectancy, more women than men live with AF. The risk of AF is higher with increasing pregnancies. Women are more symptomatic. Increased atrial fibrosis and a higher incidence of non-pulmonary vein triggers are seen in women. Women also have worse left atrial appendage function, which may contribute to the higher risk of stroke. Women are often managed with rate control and less electrical cardioversion and catheter ablation. Catheter ablation complications in women are higher in some studies but not in others. Low body weight and advanced age at presentation are possible explanations for this higher risk. Women have more complications than men when undergoing left atrial appendage occluder (LAAO) placement. Summary Sex differences need to be considered in the management of patients with AF. Women have different presentation, anatomy, and response to treatment. Further research is needed to decrease the morbidity, mortality, and complication rates in women with AF, given their longer life expectancy and its potential impact on public health. Through concerted effort among institutions, research agencies, and advocacy groups, sex differences in AF management can be recognized better at the biological and cultural levels with an increased enrollment of women, including women of child-bearing age, in clinical research with “customized” care for female patients.