The Virgin Field of Cardiac Electrophysiology for Indian Women

Women Electrophysiologists are Female cardiologists who study and treat the electrical disturbances of the heart. Out of around 150 heart rhythm specialists in the country, she stands as the first women electrophysiologist  of the country and practices at Max Healthcare Superspeciality Hospital as the Director of Cardiac Electrophysiology department.

Though the road to becoming an electrophysiologist is a long one – 12 to 13 years of training, compared to seven or eight for other areas of medicine –Electrophysiology encompasses a lot of intellect, eye of a hawk, patience, hard work and being a physician provided two important things– meaningful one-on-one interactions with patients to help them and the ability to accept and treat challenging patients.

“While this highlights how challenging this field is, it at the same time brings to fore the ample opportunities the discipline offers to women medical practitioners and students”, writes Dr Vanita Arora, Director & Head, Cardiac Electrophysiology Lab and Arrhythmia Services, Max Hospital, Saket.

She is one of the few women in Asia Pacific in this field and her research also focuses on arrhythmias and heart failure in women. She wants to uncover what makes “women different from men” when it comes to fast, slow or otherwise abnormal heart rhythms that can lead to fainting, cardiac arrest and, in the worst cases, death. Though some research does exist, it isn’t a well studied area.

There is some new data on the influence of gender on potentially life-threatening arrhythmias that originate in the lower chambers of the heart, or the ventricles. Such events, known as ventricular tachycardia and ventricular fibrillation, usually occur after an individual has suffered a heart attack. It is important to focus on cardiac arrhythmias in women because women live longer than men.

Heart Beat and Rhythm Differences Between Women and Men

What is a Heart Beat?

The human heart beats roughly 100,000 times a day, pumping blood through its chambers to the rest of the body. Over a lifetime, that corresponds to more than 2.5 billion heartbeats. A heartbeat is triggered by an electrical impulse that signals the heart's chambers to contract at the proper time.
Many people, however, have abnormal heart rhythms resulting in abnormally fast or abnormally slow heartbeats called arrhythmias. Fortunately, due to treatment advances, we are able to effectively treat most cardiac rhythm disturbances.

What are symptoms of Arrhythmias?

Some of the more noticeable symptoms include fainting, dizziness, sensation of light-headedness, sensation of heart fluttering, sensation of a missed or extra heart beat, weakness, fatigue, shortness-of-breath, chest pain, fainting episodes and an intolerance for activity.

It is important to note that not all arrhythmias have symptoms.

Why Women are Different from Men at Heart -Even Electrically

Electrical Explanation For Gender Differences:

The fact that heart of a woman is electrically wired differently from men should come as no surprise. The development of every part of the body is determined genetically, and modified by the sex hormones. The heart works through an electrical system that we can measure on the surface with the ECG.

Women Have a Faster Baseline Heart Rate Than Men:

On an average, women tend to have a faster baseline heart rate than men. This difference is seen in girls, as young as five years old.

Women’s ECG Readings may be Different:

Women are more likely than men to be seriously affected by either congenital or acquired QT (a segment in ECG) prolongation which puts them at an increased risk for drug-induced torsades de pointes (a life threatening arrhythmia).
The hormone (androgen and estrogen) levels may explain the gender differences in QT interval.
Physicians should use caution in women when prescribing any drug including antibiotics, antifungals, antidepressants, and antiarrhythmics, that can further prolong or precipitate QT prolongation as a side effect. It is not unusual to find congenital long QT syndrome as a cause of syncope and sudden death in young women.

Differences in abnormal heart rhythms in men and women

PSVT – a rapid heart rate that originates from upper chamber of heart.

Sinus Node Dysfunction (also called sick sinus syndrome) – a slow or irregular heart rhythm that originates once the main pacemaker of heart becomes slow.

Atrial fibrillation (AF)-
One of the most common irregular heart rhythms. Women are more likely to have Atrial Fibrillation associated with valvular heart disease and an increased risk for stroke and cardiovascular death as compared to men in older than age 75. However, women are less likely to receive anticoagulation and ablation procedures compared to men.

Sudden cardiac death -
As the name suggests is a sudden, unexpected death caused by loss of heart function. Sudden cardiac death (SCD) occurs less frequently in women, but is still related to about 400,000 deaths per year in women worldwide.
It has been seen that while the majority of women who had SCD had no prior history of cardiovascular disease before death, they had at least one cardiac risk factor (smoking, hypertension or diabetes). Family history also played a role in increased risk if one parent died of heart disease before age 60. The majority of SCD in women was related to an abnormality of the heart rhythm (88%). This reinforces the need for careful screening of heart disease risk factors in women and managing these concerns even without symptoms being present.

Delayed or missed diagnosis of an arrhythmia is a significant problem for women. Often, symptoms can be mistaken for other conditions including panic, stress, and anxiety and are usually not evaluated as cardiac problems.

Electrophysiologists are cardiologists with extensive specialized training in the diagnosis and treatment of heart rhythm problems. Electrophysiology department at Max Healthcare Superspeciality Hospital, New Delhi headed by a Women Cardiac Electrophysiologist Dr Vanita Arora performs over 1000 procedures every year and the program has grown into one of the most experienced lab in the country. We have become the "go to" resource within the field of arrhythmia management and care.

Snippet :-

Paradoxical Scenario
Both men and women have been shown to derive an equal survival benefit from ICD implantable cardioverter defibrillators (shocking device) and CRT cardiac resynchronization therapy (heart failure device), although these devices are significantly underutilized in women. Women also appear to have a better response to cardiac resynchronization therapy in terms of reduced numbers of hospitalizations and more robust reverse ventricular remodeling resulting in improvement of heart function and hence improvement in quality and quantity of life. But in India like others sheres of life Women though are the pillar of family but not given their due and do not receive this Device.