19th March 09:59
Article : Women Referred Later For Effective Arrhythmia Procedure
Women Referred Later For Effective Arrhythmia Procedure
September 18, 2003
BETHESDA, MD (American College of Cardiology) -- Although radiofrequency
catheter ablation treatment to zap the source of heart arrhythmias is
equally effective in men and women, female patients tend to receive
treatment significantly later than male patients, according to a new study
in the Sept. 17, 2003 issue of the Journal of the American College of
"There is no difference in the success rates, no difference in complication
rates, and no difference in recurrence rates; so the outcome is the same in
both ***es, but women are referred later than men," said Nikolaos Dagres, MD
at the Department of Cardiology and Angiology, Hospital of the Westfaelische
Wilhelms-University and Institute for Arteriosclerosis Research in Muenster,
Dr. Dagres said that although this study cannot explain why women were
referred later than men to ablation treatment, it could be that physicians
delay referring female patients or that women want to wait longer, either
because of concerns about ablation treatment or because they don't feel as
bothered by symptoms as men are. These symptoms can include racing heart
beat, heart palpitations, lightheadedness or fainting, shortness of breath,
or chest pains. Other studies have also observed a general tendency for
women to be referred later to a variety of medical treatments, but he noted
there is no medical reason for delaying ablation therapy.
"I would say these findings are in conformity with previous studies that
there could be a general tendency toward more conservative treatment in
women. On the other hand, we concluded that it's not really justified,
because there is actually no difference, either in success, complication or
recurrence rates. Women have equally excellent success rates, low
complication rates, and equally low recurrence rates as men; and there is
also no substantial difference in the procedure-related parameters," Dr.
Radiofrequency ablation involves threading a catheter through blood vessels
into the heart, where a tip emits high frequency radio waves to sever the
source of abnormal heart rhythms. Radiofrequency ablation has become
standard treatment for a variety of arrhythmias, although in many cases
patients try drug therapy first.
The researchers looked at 894 consecutive patients who underwent catheter
ablation during a 43-month period in the Department of Cardiology at the
University of Muenster in Germany, including 515 patients who were treated
for arrhythmias caused by accessory pathways, 375 patients treated for
atrioventricular nodal re-entrant tachycardia (AVNRT), and four patients
treated for both types of arrhythmias. Female patients had been experiencing
arrhythmia symptoms an average of 28 months longer than male patients (185 ±
143 vs. 157 ± 144 months after onset of symptoms, p < 0.001), had received
more antiarrhythmic drugs (1.6 ± 1.2 vs. 1.3 ± 1.1, p < 0.001), and
experienced symptoms more frequently (80.3% of women felt more than one
episode of arrhythmia per month compared to 70.3% of men).
Dr. Dagres said that not only were outcomes equally successful in male and
female patients, most procedure parameters were also equivalent. In fact,
the researchers observed that on average women received a significantly
smaller dose of radiation during fluoroscopy to image the heart.
Many patients with intermittent arrhythmias have normal electrocardiograms
when their heart beats are regular. When the researchers compared patients
according to their electrocardiogram results, they found that the gender
difference in referral times could be traced primarily to the group of
patients with normal electrocardiograms.
"My explanation for this is that when people have an abnormal
electrocardiogram, the possibility for physician bias does not exist. It's
very difficult for the physician to attribute the symptoms to panic or
stress or anxiety, when there is an abnormal electrocardiogram. The
physician would probably be more likely to refer the female patient because
there is obviously some kind of problem there," Dr. Dagres said.
Jerry C. Griffin, MD with POINT Biomedical, who was not part of this
research team, said this study has a message for physicians.
"Women derive the same benefit and are at no greater risk of complications
for ablative therapy of arrhythmias than men, yet they are referred for the
therapy later in the course of their disease. Therefore physicians should be
mindful of this in the management of women with tachyarrhythmias. The study
does not necessarily suggest that physicians are more reluctant to refer
women than men. It may well be that women are more stoic, more resistant to
considering invasive therapies, or less impacted by the diseases," he said.