title: Sex differences in cardiac autonomic regulation and in repolarisation electrocardiography.
abstract: The review summarises the present knowledge on the sex differences in cardiac autonomic regulations and in related aspects of electrocardiography with particular attention to myocardial repolarisation. Although some of the sex differences are far from fully established, multitude of observations show consistent differences between women and men. Despite more pronounced parasympathetic cardiac regulation, women have higher resting heart rate and lower baroreflex sensitivity. Of the electrocardiographic phenomena, women have longer QT interval duration, repolarisation sequence more synchronised with the inverse of the depolarisation sequence, and likely increased regional heterogeneity of myocardial repolarisation. Studies investigating the relationship of these sex disparities to hormonal differences led frequently to conflicting results. Although sex hormones seem to play a key role by influencing both autonomic tone and electrophysiological properties at the cellular level, neither the truly relevant hormones nor their detailed actions are known. Physiologic usefulness of the described sex differences is also unknown. The review suggests that new studies are needed to advance the understanding of the physiologic mechanisms responsible for these inequalities between women and men and provides key methodological suggestions that need to be followed in future research.
authors: Wilhelminenspital der Stadt Wien, Vienna, Austria.
authors: Peter
authors: P
authors: Smetana
authors: Marek
authors: M
authors: Malik
mesh_terms: D001341:Autonomic Nervous System / Q000502:physiology*; D017704:Baroreflex; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000294:innervation / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D012727:Sex Characteristics
references: Mayo Clin Proc. 1988 Feb;63(2):137-46
references: 3276974
references: Am J Cardiol. 1979 Jul;44(1):53-9
references: 453046
references: Cardiovasc Res. 2003 Jan;57(1):28-36
references: 12504811
references: Hum Genet. 1998 Jul;103(1):34-40
references: 9737773
references: Postgrad Med. 1990 May 15;87(7):55-60
references: 2188241
references: Fundam Clin Pharmacol. 2006 Feb;20(1):1-8
references: 16448390
references: Adv Physiol Educ. 2007 Mar;31(1):17-22
references: 17327577
references: Hellenic J Cardiol. 2007 Sep-Oct;48(5):278-89
references: 17966683
references: Cardiovasc Res. 2002 Feb 15;53(3):763-9
references: 11861046
references: Psychosom Med. 2011 Oct;73(8):683-9
references: 21949428
references: Klin Wochenschr. 1986 Jun 2;64(11):499-505
references: 3723997
references: Am J Physiol Heart Circ Physiol. 2009 Aug;297(2):H765-74
references: 19465541
references: Circulation. 1965 Jun;31:888-98
references: 14297523
references: Am J Physiol Heart Circ Physiol. 2003 Nov;285(5):H2188-93
references: 12881217
references: Curr Opin Cardiol. 2004 Jan;19(1):2-11
references: 14688627
references: Circ Res. 1991 Jun;68(6):1729-41
references: 2036721
references: Phys Sportsmed. 2010 Jun;38(2):156-64
references: 20631475
references: J Electrocardiol. 2012 Nov-Dec;45(6):571-81
references: 22999325
references: J Appl Physiol (1985). 2001 Nov;91(5):2088-92
references: 11641348
references: Hypertension. 1993 Apr;21(4):498-503
references: 8458648
references: Pacing Clin Electrophysiol. 2002 Feb;25(2):209-16
references: 11915990
references: Am J Obstet Gynecol. 2002 May;186(5):954-61
references: 12015521
references: Am J Cardiol. 1997 Aug 1;80(3):302-5
references: 9264423
references: Circulation. 1991 Aug;84(2):482-92
references: 1860193
references: J Electrocardiol. 2000;33 Suppl:219-27
references: 11265725
references: J Physiol. 2008 Jun 15;586(12):2961-73
references: 18440994
references: Eur Heart J. 2003 Sep;24(18):1663-7
references: 14499229
references: Am J Physiol. 1996 Feb;270(2 Pt 1):E363-6
references: 8779960
references: Hypertension. 1987 Nov;10(5):538-43
references: 3666866
references: Clin Sci (Lond). 2007 Jun;112(6):353-61
references: 17129210
references: Circulation. 1992 Feb;85(2):497-503
references: 1735146
references: Ann Noninvasive Electrocardiol. 2008 Apr;13(2):191-207
references: 18426445
references: J Physiol. 2011 Nov 1;589(Pt 21):5285-97
references: 21859824
references: Basic Res Cardiol. 2004 May;99(3):183-92
references: 15088103
references: Am J Physiol Heart Circ Physiol. 2008 Dec;295(6):H2356-63
references: 18849333
references: Am J Epidemiol. 1999 May 1;149(9):853-62
references: 10221322
references: Circ Res. 2008 May 9;102(9):e86-100
references: 18436794
references: Eur Heart J. 1997 Jun;18(6):1000-6
references: 9183593
references: Circulation. 2000 Sep 26;102(13):1473-6
references: 11004135
references: Cardiovasc Res. 2002 Feb 15;53(3):678-87
references: 11861039
references: Am J Cardiol. 1997 Sep 15;80(6):815-7
references: 9315602
references: Am J Med. 1996 May;100(5):537-43
references: 8644766
references: Am J Cardiol. 1998 Oct 15;82(8):993-5
references: 9794362
references: Circulation. 2001 Jan 23;103(3):375-80
references: 11157688
references: Am J Cardiol. 1995 Jun 15;75(17):1277-8
references: 7778558
references: Pharmacol Ther. 2010 Jul;127(1):9-18
references: 20462510
references: J Electrocardiol. 1997 Oct;30(4):267-76
references: 9375902
references: J Cardiovasc Electrophysiol. 2008 Apr;19(4):386-91
references: 18031506
references: J Am Coll Cardiol. 1996 Jan;27(1):76-83
references: 8522713
references: Ann Noninvasive Electrocardiol. 2004 Oct;9(4):366-74
references: 15485516
references: Ann N Y Acad Sci. 2001 Jun;940:1-19
references: 11458669
references: Am J Physiol. 1999 Apr;276(4):R1030-7
references: 10198382
references: J Hypertens Suppl. 1985 Dec;3(3):S79-81
references: 2856787
references: J Heart Valve Dis. 2012 Jan;21(1):31-6
references: 22474739
references: J Womens Health. 1998 Jun;7(5):547-57
references: 9650155
references: Am J Cardiol. 1993 Aug 26;72(6):23B-25B
references: 8256751
references: J Electrocardiol. 2000;33 Suppl:229-37
references: 11265726
references: Ann Noninvasive Electrocardiol. 2010 Jan;15(1):11-6
references: 20146777
references: Am J Physiol. 1998 Dec;275(6):R1909-20
references: 9843880
references: Am J Cardiol. 1993 Aug 26;72(6):17B-22B
references: 8256750
references: J Cardiovasc Electrophysiol. 1999 Aug;10(8):1124-52
references: 10466495
references: Arch Intern Med. 1995 Mar 13;155(5):469-73
references: 7864703
references: J Clin Pharmacol. 1998 Jul;38(7):618-24
references: 9702846
references: Circ Cardiovasc Genet. 2011 Oct;4(5):516-22
references: 21836130
references: Cardiovasc Res. 2003 Jun 1;58(3):549-54
references: 12798427
references: Am J Physiol Heart Circ Physiol. 2004 Jan;286(1):H131-6
references: 12946934
references: Eur Heart J. 2006 Sep;27(18):2177-83
references: 16882677
references: Circulation. 2002 Feb 12;105(6):714-9
references: 11839627
references: Circulation. 1999 May 4;99(17):2251-4
references: 10226089
references: Am J Hypertens. 2000 Mar;13(3):268-75
references: 10777031
references: J Cardiovasc Electrophysiol. 2000 Aug;11(8):835-43
references: 10969744
references: J Electrocardiol. 1994;27 Suppl:62-6
references: 7884377
references: Eur J Clin Invest. 2001 Jul;31(7):563-9
references: 11454009
references: J Am Coll Cardiol. 2002 Aug 7;40(3):511-4
references: 12142119
references: J Am Coll Cardiol. 1994 Dec;24(7):1700-7
references: 7963118
references: Hypertension. 1981 Nov-Dec;3(6 Pt 2):II-134-7
references: 7298132
references: Eur Heart J. 1996 Mar;17(3):354-81
references: 8737210
references: Hum Genet. 1999 Dec;105(6):654-61
references: 10647902
references: Circulation. 2002 Mar 5;105(9):1066-70
references: 11877356
references: J Electrocardiol. 2008 Nov-Dec;41(6):648-55
references: 18817923
references: Cardiovasc Res. 1972 May;6(3):277-83
references: 5035598
references: Am J Cardiol. 1987 Feb 1;59(4):256-62
references: 3812275
references: Chest. 1979 Apr;75(4):474-80
references: 156105
references: J Electrocardiol. 2001 Oct;34(4):277-83
references: 11590553
references: JAMA. 1994 Mar 16;271(11):840-4
references: 8114238
references: Am J Cardiol. 1992 Sep 15;70(7):797-801
references: 1519533
references: Clin Auton Res. 2001 Apr;11(2):99-108
references: 11570610
references: J Electrocardiol. 2003;36 Suppl:187-90
references: 14716631
references: J Clin Pathol. 2011 Apr;64(4):358-62
references: 21059599
references: Circulation. 1998 Feb 10;97(5):451-6
references: 9490239
references: Am J Physiol. 1999 Feb;276(2):R474-81
references: 9950927
references: Cardiology. 2001;95(3):131-8
references: 11474158
references: Clin Sci (Lond). 2000 Nov;99(5):371-81
references: 11052917
references: Am J Cardiol. 2007 Sep 1;100(5):844-9
references: 17719331
references: Am Heart J. 2000 Oct;140(4):678-83
references: 11011345
references: Circulation. 1997 Nov 4;96(9):3006-12
references: 9386169
references: Circulation. 1998 Nov 24;98(21):2314-22
references: 9826320
references: Ann Noninvasive Electrocardiol. 2001 Oct;6(4):280-4
references: 11686907
references: Int J Obes Relat Metab Disord. 1993 Aug;17(8):465-9
references: 8401749
references: Circulation. 2002 Mar 19;105(11):1329-35
references: 11901044
references: N Engl J Med. 1998 Jun 11;338(24):1709-14
references: 9624190
references: Circulation. 1978 Jun;57(6):1074-7
references: 639227
references: Clin Sci (Lond). 2002 Jun;102(6):639-44
references: 12049617
references: Sleep Med. 2005 Nov;6(6):561-6
references: 16198144
references: Am J Physiol. 1987 Sep;253(3 Pt 2):H680-9
references: 3631301
references: Cardiovasc Res. 2003 Mar;57(3):625-31
references: 12618224
references: Pacing Clin Electrophysiol. 2012 Dec;35(12):1409-10
references: 23036086
references: Pacing Clin Electrophysiol. 2006 Jun;29(6):607-13
references: 16784426
references: Pacing Clin Electrophysiol. 2003 Jan;26(1 Pt 1):59-64
references: 12685141
references: Am J Physiol Heart Circ Physiol. 2006 Aug;291(2):H570-80
references: 16501015
references: Fetal Diagn Ther. 2006;21(1):144-7
references: 16354993
references: J Electrocardiol. 2007 Jul;40(3):228-34
references: 17276451
references: Circ Res. 2001 Aug 31;89(5):437-44
references: 11532905
references: Circulation. 1993 Jul;88(1):107-15
references: 8319323
references: Heart. 2002 Mar;87(3):220-8
references: 11847158
references: Maturitas. 2003 Jan 30;44(1):39-48
references: 12568734
references: Ann Noninvasive Electrocardiol. 2002 Jan;7(1):60-3
references: 11844293
references: Circulation. 1994 Aug;90(2):779-85
references: 8044948
references: J Am Coll Cardiol. 1984 Dec;4(6):1222-30
references: 6238987
references: Circulation. 1982 Mar;65(3):435-9
references: 7055864
references: Ann Noninvasive Electrocardiol. 2010 Jan;15(1):3-10
references: 20146776
references: Am J Cardiol. 1989 Mar 1;63(9):606-9
references: 2919564
references: J Clin Endocrinol Metab. 2002 Apr;87(4):1569-75
references: 11932284
references: Psychosom Med. 1995 Jul-Aug;57(4):331-5
references: 7480562
references: Pacing Clin Electrophysiol. 2005 Jan;28 Suppl 1:S172-7
references: 15683490
references: Am J Cardiol. 1982 Nov;50(5):1099-103
references: 7137037
references: Pacing Clin Electrophysiol. 2000 Nov;23(11 Pt 2):1957-9
references: 11139966
references: JAMA. 2001 Mar 14;285(10):1322-6
references: 11255387
references: Am J Epidemiol. 1979 Sep;110(3):274-80
references: 474564
references: Age Ageing. 2003 May;32(3):326-31
references: 12720621
references: J Electrocardiol. 2011 Nov-Dec;44(6):645-9
references: 21907997
references: Circulation. 2005 Sep 20;112(12):1701-10
references: 16157773
references: Am Heart J. 1991 Feb;121(2 Pt 1):524-30
references: 1990758
references: Am J Epidemiol. 2011 Aug 15;174(4):403-11
references: 21768401
references: Eur Heart J. 1999 Feb;20(4):278-84
references: 10099922
references: Pacing Clin Electrophysiol. 1998 Jan;21(1 Pt 2):172-5
references: 9474667
references: J Am Coll Cardiol. 2002 Jun 5;39(11):1820-6
references: 12039498
references: Circulation. 1982 Jun;65(6):1236-42
references: 7074781
references: J Hypertens. 1999 Nov;17(11):1589-99
references: 10608473
references: AJR Am J Roentgenol. 2011 Apr;196(4):788-94
references: 21427326
references: J Electrocardiol. 2004 Jul;37(3):191-200
references: 15286932
references: Hypertension. 2010 Dec;56(6):1118-23
references: 21060001
references: Circulation. 1997 Sep 16;96(6):1863-73
references: 9323074
references: Hypertension. 2001 Mar;37(3):911-6
references: 11244017
references: Am Heart J. 1953 Jul;46(1):9-20
references: 13057814
references: Circulation. 2003 Feb 11;107(5):740-6
references: 12578878
references: Circulation. 1995 Sep 1;92(5):1209-16
references: 7648667
references: Am J Cardiol. 2000 Apr 1;85(7):908-10, A10
references: 10758940
references: Am J Physiol. 1998 Nov;275(5):R1600-4
references: 9791079
references: Circulation. 1996 Sep 15;94(6):1471-4
references: 8823008
references: Acta Physiol (Oxf). 2006 Feb;186(2):103-10
references: 16497187
references: Am J Physiol Heart Circ Physiol. 2002 Jun;282(6):H2356-63
references: 12003846
references: Med J Aust. 1978 Jul 15;2(2):52-3
references: 713911
references: J Electrocardiol. 2006 Jan;39(1):67-72
references: 16387055
references: Pacing Clin Electrophysiol. 1998 Nov;21(11 Pt 2):2376-81
references: 9825351
references: Am Heart J. 1998 Aug;136(2):205-12
references: 9704680
references: J Electrocardiol. 2011 May-Jun;44(3):301-8
references: 21511064
references: Am J Physiol Heart Circ Physiol. 2007 Aug;293(2):H1013-22
references: 17400723
references: J Electrocardiol. 2007 Jan;40(1):12-7
references: 17067623
references: Med Biol Eng Comput. 1999 Jan;37(1):71-9
references: 10396845
references: Circulation. 1998 Nov 3;98(18):1928-36
references: 9799215
references: Int J Cardiol. 2003 Jan;87(1):37-51
references: 12468053
references: Am J Physiol. 1996 Jul;271(1 Pt 2):H303-10
references: 8760189
references: J Pharmacol Exp Ther. 1998 Jun;285(3):1068-72
references: 9618409
references: J Appl Physiol (1985). 2001 Dec;91(6):2611-8
references: 11717226
references: J Appl Physiol (1985). 1998 Feb;84(2):576-83
references: 9475868
references: J Electrocardiol. 1998;30 Suppl:64-8
references: 9535482
references: Chest. 2001 Feb;119(2):507-10
references: 11171730
references: Lancet. 1999 Jun 5;353(9168):1939-40
references: 10371580
references: Can J Cardiol. 1992 Sep;8(7):690-5
references: 1422988
references: Heart Rhythm. 2005 Feb;2(2):162-9
references: 15851290
references: Circulation. 1999 Apr 13;99(14):1843-50
references: 10199881
references: Circ Cardiovasc Imaging. 2010 Jan;3(1):54-64
references: 19996380
references: Maturitas. 2000 Jul 31;36(1):43-7
references: 10989241
references: J Electrocardiol. 1996;29 Suppl:154-60
references: 9238392
references: Circulation. 1967 Apr;35(4):724-33
references: 4225806
references: Circulation. 1991 Feb;83(2):484-91
references: 1991367
references: J Electrocardiol. 1998;31 Suppl:121-5
references: 9988015
references: Circulation. 2000 Sep 12;102(11):1252-7
references: 10982539
references: Exp Physiol. 2003 May;88(3):441-6
references: 12719769
references: Circulation. 1999 Apr 13;99(14):1816-21
references: 10199877
references: Eur J Clin Invest. 2001 Apr;31(4):293-301
references: 11298775
references: Hypertension. 2009 Mar;53(3):571-6
references: 19171792
references: J Am Coll Cardiol. 2007 Mar 13;49(10):1109-27
references: 17349896
references: Ann Noninvasive Electrocardiol. 2010 Jul;15(3):264-75
references: 20645970
references: Med Biol Eng Comput. 1999 Sep;37(5):574-84
references: 10723894
references: J Electrocardiol. 2008 Nov-Dec;41(6):491-7
references: 18817925
references: J Electrocardiol. 1999 Jan;32(1):33-43
references: 10037087
references: Am J Hypertens. 1993 Nov;6(11 Pt 2):309S-313S
references: 8297537
references: J Am Coll Cardiol. 1996 Nov 15;28(6):1547-55
references: 8917270
references: J Am Coll Cardiol. 2002 Nov 20;40(10):1870-6
references: 12446073
references: Scand Cardiovasc J. 2001 Oct;35(5):313-7
references: 11771822
references: Child Dev. 1952 Dec;23(4):237-45
references: 13042891
references: IEEE Trans Biomed Eng. 2004 Sep;51(9):1511-20
references: 15376499
references: Am J Cardiol. 1997 Jan 15;79(2):178-81
references: 9193019
references: Am J Cardiol. 1998 Mar 15;81(6):755-60
references: 9527087
references: J Auton Nerv Syst. 1997 Sep 10;66(1-2):69-74
references: 9334995
references: Circulation. 1990 Mar;81(3):815-20
references: 2137733
references: Circulation. 2001 May 1;103(17):2207-12
references: 11331264
references: Circulation. 2002 Nov 5;106(19):2473-8
references: 12417545
references: J Electrocardiol. 1982 Apr;15(2):115-8
references: 7069326
references: Int J Cardiol. 2001 Dec;81(2-3):169-74
references: 11744133
references: Acad Emerg Med. 2010 Aug;17(8):801-8
references: 20670316
references: Am J Cardiol. 2001 Feb 1;87(3):354-6, A9-10
references: 11165979
references: J Electrocardiol. 1994;27 Suppl:14-9
references: 7884351
references: Eur Heart J. 1998 Sep;19(9):1334-41
references: 9792258
references: Am J Cardiol. 2007 Aug 1;100(3):524-7
references: 17659940
references: Maturitas. 2000 Nov 30;37(1):45-51
references: 11099873
references: Am J Cardiol. 2009 Mar 15;103(6):887-90
references: 19268751
references: Br Heart J. 1986 Apr;55(4):348-54
references: 3964501
references: Clin Sci (Lond). 1997 Oct;93(4):309-16
references: 9404222
references: J Electrocardiol. 2000;33 Suppl:239-44
references: 11265728
references: Clin Sci (Lond). 1999 Oct;97(4):515-22
references: 10491352
references: Br Heart J. 1994 Jan;71(1):34-7
references: 8297691
references: Am J Cardiol. 2006 Feb 1;97(3):309-15
references: 16442387
references: J Physiol. 2012 May 1;590(9):2069-79
references: 22351633
references: Circulation. 2000 Feb 29;101(8):862-8
references: 10694525
references: Pacing Clin Electrophysiol. 2009 Jan;32(1):119-30
references: 19140922
references: J Pharmacol Exp Ther. 1998 May;285(2):672-9
references: 9580612
references: Cardiovasc Res. 1995 Aug;30(2):161-5
references: 7585800
references: Eur Heart J. 2001 Apr;22(8):702-11
references: 11286528
references: Am J Cardiol. 2000 Mar 15;85(6):787-9, A9
references: 12000064
references: J Physiol. 2011 Mar 1;589(Pt 5):1061-80
references: 21224239
references: J Cardiovasc Electrophysiol. 1995 Nov;6(11):1032-8
references: 8589872
references: Heart Rhythm. 2012 May;9(5):833-4
references: 22266129
references: Circulation. 2004 Nov 2;110(18):2792-6
references: 15492317
references: Pacing Clin Electrophysiol. 2006 Nov;29(11):1277-84
references: 17100684
references: Pediatr Cardiol. 1996 May-Jun;17(3):135-6
references: 8662028
references: Circulation. 2001 Jul 3;104(1):32-8
references: 11435334
references: Cardiovasc Res. 1970 Apr;4(2):160-7
references: 4192616
references: Eur Heart J. 2009 Jan;30(2):202-8
references: 18832384
references: Am J Cardiol. 1995 Nov 1;76(12):906-12
references: 7484830
references: Circulation. 1995 Apr 1;91(7):1936-43
references: 7895350
references: J Clin Epidemiol. 2003 Jun;56(6):565-71
references: 12873652
references: Am J Physiol Heart Circ Physiol. 2002 May;282(5):H1889-97
references: 11959656
references: Pacing Clin Electrophysiol. 2001 Jan;24(1):16-21
references: 11227963
references: J Clin Endocrinol Metab. 1982 Oct;55(4):703-8
references: 7107815
references: Am J Physiol Regul Integr Comp Physiol. 2003 Nov;285(5):R1091-7
references: 12881201
references: Curr Opin Cardiol. 2007 Jan;22(1):39-43
references: 17143043
references: Circulation. 1965 Nov;32(5):746-54
references: 5846397
references: Card Electrophysiol Rev. 2002 Sep;6(3):245-9
references: 12114846
references: Hypertension. 2001 Mar;37(3):907-10
references: 11244016
references: Circulation. 1996 Jul 15;94(2):122-5
references: 8674168
references: Cardiovasc Res. 2002 Feb 15;53(3):752-62
references: 11861045
references: Singapore Med J. 2011 Apr;52(4):241-4; quiz 245
references: 21552783
references: Circ Res. 1969 Jan;24(1):109-21
references: 4303309
references: J Appl Physiol (1985). 1994 Aug;77(2):606-13
references: 8002506
references: Circ Cardiovasc Imaging. 2010 Jan;3(1):65-76
references: 19820203
references: Am Heart J. 2000 Sep;140(3):430-6
references: 10966541
references: JAMA. 1993 Dec 1;270(21):2590-7
references: 8230644
references: J Am Coll Cardiol. 1998 Mar 1;31(3):593-601
references: 9502641
references: Am J Cardiol. 2002 Dec 15;90(12):1290-3
references: 12480036
references: Exp Physiol. 2000 May;85(3):327-30
references: 10825420
references: Am J Cardiol. 2002 Nov 15;90(10):1050-5
references: 12423702
references: Circulation. 2001 Jun 19;103(24):2909-14
references: 11413079
references: Hypertension. 1989 Aug;14(2):218-26
references: 2759681