Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia and continues to increase in prevalence and incidence as the population ages. The diagnosis of AF confers a huge burden due to healthcare costs, patient symptoms, and impaired quality of life. This chapter examines sex differences in AF with respect to epidemiology, pathophysiology, presentation, access to treatment, prognosis, and risk of thromboembolism. While lifetime incidence of AF is the same between the sexes, women tend to be older at the time of presentation, lagging behind men by about 10 years. Compared to men, women are more likely to be symptomatic and experience more functional limitations. They have a higher mortality risk and are less likely to be referred for interventions such as catheter ablation or electrical cardioversion. Therapeutic anticoagulation is underused in elderly women, who are at a particularly high risk for debilitating stroke. Women are more likely to experience major bleeding while on anticoagulants, have more medication side effects, and have more procedural complications than men. This chapter highlights the unanswered questions in sex-specific differences in AF, and emphasizes the need for future studies. Recognizing and understanding key sex differences can improve treatment of all patients with AF. Given the vast prevalence and ever-growing incidence of AF, the global impact of such adaptations cannot be underemphasized.