Sex-specific triggers for right ventricular outflow tract tachycardia.
BACKGROUND
Right ventricular outflow tract tachycardia (RVOT-VT) is a common arrhythmia in young patients without heart disease. The arrhythmia is characterized by repetitive bursts and premature ventricular contractions with a left bundle branch block, inferior-axis QRS morphology, and symptoms of palpitations. Although more frequent in women, sex-specific triggers for symptomatic RVOT-VT have not been identified.


RESULTS
We interviewed 34 women and 13 men referred for ablation of RVOT-VT to determine if predictable but sex-specific exacerbations in symptomatic RVOT-VT exist. After a general query asking if there was predictability to what triggered palpitations, we then specifically queried all patients about symptomatic RVOT-VT initiation with exercise, stress, caffeine, fatigue, and, in women only, periods of recognized hormonal flux. The times identified as states of hormonal flux included premenstrual, gestational, perimenopausal, and coincident with the administration of birth control pills. In response to the completed interview, the most common recorded trigger for RVOT-VT in women was recognized states of hormonal flux with 20 (59%) of 34 women responding positively and 14 (41%) of the 34 indicating that states of hormonal flux were the only recognizable triggers. Men were more likely than women to report that their RVOT-VT was predictably triggered by exercise, stress, or caffeine: 12 (92%) of 13 men versus 14 (41%) of 34 women (P <.01).


CONCLUSIONS
Triggers for RVOT-VT initiation are sex specific. Women have RVOT-VT initiation with recognized states of hormonal flux. Men more commonly have RVOT-VT initiated by exercise or stress. These data have important implications related to patient education and counseling in the setting of RVOT-VT and may influence the timing of drug treatment and electrophysiologic evaluation in selected patients.
Marchlinski
F E
FE
Electrophysiology Section, Cardiology Division of the University of Pennsylvania Health System, Philadelphia 19104, USA. Marchlin@mail.med.upenn.edu
Deely
M P
MP
Zado
E S
ES
D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D002110:Caffeine / Q000009:adverse effects; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D003271:Contraceptive Agents, Female / Q000009:adverse effects; D004562:Electrocardiography; D005080:Exercise Test / Q000009:adverse effects; D005260:Female; D006339:Heart Rate; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017698:Postmenopause / Q000097:blood; D011247:Pregnancy / Q000097:blood; D017697:Premenopause / Q000097:blood; D011379:Prognosis; D012737:Sex Factors; D011795:Surveys and Questionnaires; D017180:Tachycardia, Ventricular / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D018879:Ventricular Premature Complexes / Q000097:blood / Q000209:etiology* / Q000503:physiopathology
D000697:Central Nervous System Stimulants; D003271:Contraceptive Agents, Female; D002110:Caffeine