Gender differences in autonomic modulation of ventricular repolarization in humans.
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 beta-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).


CONCLUSIONS
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.
Nakagawa
Mikiko
M
Department of Cardiovascular Science, Division of Laboratory Medicine, Oita University , School of Medicine, Oita, Japan. mikinak@oita-med.ac.jp
Ooie
Tatsuhiko
T
Ou
Baiqing
B
Ichinose
Masashi
M
Takahashi
Naohiko
N
Hara
Masahide
M
Yonemochi
Hidetoshi
H
Saikawa
Tetsunori
T
D000328:Adult; D001285:Atropine / Q000494:pharmacology*; D001341:Autonomic Nervous System / Q000187:drug effects*; D004198:Disease Susceptibility; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D008133:Long QT Syndrome / Q000139:chemically induced / Q000235:genetics / Q000503:physiopathology*; D008297:Male; D011433:Propranolol / Q000494:pharmacology*; D011943:Receptors, Adrenergic, beta / Q000187:drug effects*; D012307:Risk Factors; D012737:Sex Factors; D016171:Torsades de Pointes / Q000139:chemically induced / Q000235:genetics / Q000503:physiopathology*; D016276:Ventricular Function / Q000187:drug effects / Q000502:physiology*
D011943:Receptors, Adrenergic, beta; D001285:Atropine; D011433:Propranolol; D007545:Isoproterenol