Since its implementation into the clinical medicine by Willem Einthoven electrocardiography had become one of crucial diagnostic method in cardiology. In spite of this fact effects of gender differences on parameters of electrocardiographic recordings started to be studied only recently. Sex related differences in physiological ECG are only minimal in childhood but there are developing during adolescence reflecting rapidly evolving differences particularly in hormonal secretion and activity of an autonomic nervous system. The heart rate is approximately 7 % higher in women than in men, PQ and QRS intervals are longer in men while QT interval is longer in women. The ST segment in females is flatter but generally the sex-related differences in ST-T waveform patterns are relatively very small with higher level of ST segment and taller T wave in men. The effects of sex-related differences, including sex hormones, on cardiac cell injury and death and their influence in determining rhythmogenesis and action potential configuration and conduction play an important role in clinics. Women have a higher prevalence of sick sinus syndrome, inappropriate sinus tachycardia, atrioventricular nodal reentry tachycardia, idiopathic right ventricular tachycardia, and arrhythmic events in the long QT syndrome. In contrast, men have a higher prevalence of atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia due to accessory pathways, Wolff-Parkinson-White syndrome, reentrant ventricular tachycardia, ventricular fibrillation and sudden death, and the Brugada syndrome.

Institute of Physiology 1st Medical Faculty Charles University Prague Czech Republic

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Dantas AP, Fortes ZB, De Carvalho MH. Vascular disease in diabetic women: why do they miss the female protection? Exp Dia Res. 2012;2012:570–598. doi: 10.1155/2012/570598. PubMed DOI PMC

Kozlikova K, Trnka M. Varied onset of heart ventricular depolarization in different age groups of healthy volunteers. Physiol Res. 2019;68(Suppl 4):S389–S397. doi: 10.33549/physiolres.934379. PubMed DOI

Liao Y, Liu K, Dyer A, Schoenberger JA, Shekelle RB, Collette P, Stamler J. Sex differential in the relationship of electrocaridographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago Heart Association Detection Project in Industry. Circulation. 1987;75:347–352. doi: 10.1161/01.CIR.75.2.347. PubMed DOI

De Bacquer D, De Backer G, Kornitzer M, Blackburn H. Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women. Heart. 1998;80:570–577. doi: 10.1136/hrt.80.6.570. PubMed DOI PMC

Rautahraju PM. The Femal Electrocardiogram. Special Reporalization Features Gender Differences, and the Risk of Adverse Cardiac Events RAUTAHARJU PM. Springer International Publishing; Switzerland: 2015. ST-T waveform features, QT and mortality risk; pp. 97–107. DOI

Yang SG, Mlček M, Kittnar O. Estrogen can modulate menopausal women's heart rate variability. Physiol Res. 2013;62(Suppl 1):S165–S171. doi: 10.33549/physiolres.932612. PubMed DOI

Kvadsheim E, Sørensen L, Fasmer OB, Osnes B, Haavik J, Williams DWP, Thayer JF, Koenig J. Vagally mediated heart rate variability, stress, and perceived social support: a focus on sex differences. Stress. 2022;25:113–121. doi: 10.1080/10253890.2022.2043271. PubMed DOI

Kemp AH, Quintana DS, Kuhnert R-L, Griffiths K, Hickie IB, Guastella AJ. Oxytocin increases heart rate variability in humans at rest: implications for social approach-related motivation and capacity for social engagement. PLoS One. 2012;7:1–6. doi: 10.1371/journal.pone.0044014. PubMed DOI PMC

Kanthak MK, Chen FS, Kumsta R, Hill LK, Thayer JF, Heinrichs M. Oxytocin receptor gene polymorphism modulates the effects of social support on heart rate variability. Biological Psychology. 2016;117:43–49. doi: 10.1016/j.biopsycho.2016.02.0073. PubMed DOI PMC

Burke J, Goldberger J, Ehlert FA, Kruse JT, Parker MA, Kadish AH. Gender differences in heart rate before and after autonomicblockade: Evidence against an intrinsic gender effect. Am J Med. 1996;100:537–543. doi: 10.1016/S0002-9343(96)00018-6. PubMed DOI

Mason JW, Ramseth DJ, Chanter DO, Moon TE, Goodman DB, Mendzelevski B. Electrocardiographic reference ranges derived from 79,743 ambulatory subjects. J Electrocardiol. 2007;40:228–234. doi: 10.1016/j.jelectrocard.2006.09.003. PubMed DOI

Rautaharju PM, Mason JW, Akiyama T. New age- and sex-specific criteria for QT prolongation based on rate correction formulas that minimize bias at the upper normal limits. Int J Cardiol. 2014;174:535–540. doi: 10.1016/j.ijcard.2014.04.133. PubMed DOI

Kawel N, Turkbey EB, Carr JJ, Eng J, Gomes AS, Hundley WG, Johnson C, Masri SC, Prince MR, van der Geest RJ, Lima JAC, Bluemke DA. Normal left ventricular myocardial thickness for middle-aged and older subjects with steady-state free precession cardiac magnetic resonance: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging. 2012;5:500–508. doi: 10.1161/CIRCIMAGING.112.973560. PubMed DOI PMC

Rautaharju PM, Zhou SH, Wong S, Calhoun HP, Berenson GS, Prineas R, Davignon A. Sex differences in the evolution of the electrocardiographic QT interval with age. Can J Cardiol. 1992;8:690–695. PubMed

Rosano GMC, Leonardo F, Sarrel PM, Beale CM, De Luca F, Collins P. Cyclical variation in paroxysmal supraventricular tachycardia in women. Lancet. 1996;347:786–788. doi: 10.1016/S0140-6736(96)90867-3. PubMed DOI

Bidoggia H, Maciel JP, Capalozza N, Mosca S, Blaksley EJ, Valverde E, Bertran G, Arini P, Biagetti MO, Quinteiro RA. Sex differences on the electrocardiographic pattern of cardiac repolarization: possible role of testosterone. Am Heart J. 2000;140:678–683. https://doi.org/10.1067/mhj.2000.109918, https://doi.org/10.1067/mhj.2000.108510. PubMed DOI

Charbit B, Christin-Maître S, Démolis JL, Soustre E, Young J, Funck-Brentano C. Effects of testosterone on ventricular repolarization in hypogonadic men. Am J Cardiol. 2009;103:887–890. doi: 10.1016/j.amjcard.2008.11.041. PubMed DOI

Ezaki K, Nakagawa M, Taniguchi Y, Nagano Y, Teshima Y, Yufu K, Takahashi N, Nomura T, Satoh F, Mimata H, Saikawa T. Gender differences in the ST segment: effect of androgen-deprivation therapy and possible role of testosterone. Circ J. 2010;74:2448–2454. doi: 10.1253/circj.CJ-10-0221. PubMed DOI

Kittnar O. Selected sex related differences in pathophysiology of cardiovascular system. Physiol Res. 2020;69:21–31. doi: 10.33549/physiolres.934068. PubMed DOI PMC

Bernal O, Moro C. Cardiac arrhythmias in women. Rev Esp Cardiol. 2006;59:609–618. doi: 10.1157/13089748. PubMed DOI

Larsen JA, Kadish AH. Effects of gender on cardiac arrhythmia. J Cardiovasc Electrophysiol. 1998;9:655–664. doi: 10.1111/j.1540-8167.1998.tb00950.x. PubMed DOI

Ghani A, Maas AHEM, Delnoy PPHM, Ramdat Misier AR, Ottervanger JP, Elvan A. Sex-based differences in cardiac arrhythmias, ICD utilisation and cardiac resynchronisation therapy. Neth Heart J. 2011;19:35–40. doi: 10.1007/s12471-010-0050-8. PubMed DOI PMC

Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a popula-tion-based cohort: The Framingham Study. J Am Med Assoc. 1994;271:840–844. doi: 10.1001/jama.271.11.840. PubMed DOI

Carna Z, Osmancik P. The Effect of Obesity, Hypertension, Diabetes Mellitus, Alcohol, and Sleep Apnea on the Risk of Atrial Fibrillation. Physiol Res. 2021;70(Suppl 4):S511–S525. doi: 10.33549//physiolres.934744. PubMed DOI PMC

Hnatkova K, Walstare JEP, Murgatroyd FD. Age and gender influences on rate and duration of paroxysmal atrial fibrillation. PACE. 1998;21:2455–2458. doi: 10.1111/j.1540-8159.1998.tb01200.x. PubMed DOI

Yarnoz MJ, Curtis AB. More reasons why men and women are not the same (gender differences in electrophysiology and arrhythmias) Am J Cardiol. 2008;101:1291–1296. doi: 10.1016/j.amjcard.2007.12.027. PubMed DOI

Nakagawa M, Takahashi N, Nobe S, Ichinose M, Ooie T, Yufu F, Shigematsu S, Hara M, Yonemochi H, Saikawa T. Gender differences in various types of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol. 2002;13:633–638. doi: 10.1046/j.1540-8167.2002.00633.x. PubMed DOI

Odening KE, Koren G. How do sex hormones modify arrhythmogenesis in long QT syndrome? Sex hormone effects on arrhythmogenic substrate and triggered activity. Heart Rhythm Society. 2014;11:2107–2115. doi: 10.1016/j.hrthm.2014.06.023. PubMed DOI PMC

Locati EH, Zareba W, Moss AJ, Schwartz PJ, Vincent GM, Lehmann MH, Towbin JA, Priori SG, Napolitano C, Robinson JL, Andrews M, Timothy K, Hall WJ. Age- and sex-related differences in clinical manifestations in patients with congenital long-QT syndrome: findings from the International LQTS Registry. Circulation. 1998;97:2237–2244. doi: 10.1161/01.CIR.97.22.2237. PubMed DOI

Schwartz PJ, Spazzolini C, Crotti L, Bathen J, Amlie JP, Timothy K, Shkolnikova M, Berul CI, Bitner-Glindzicz M, Toivonen L, Horie M, Schulze-Bahr E, Denjoy I. The Jervell and Lange-Nielsen syndrome: natural history, molecular basis, and clinical outcome. Circulation. 2006;113:783–790. doi: 10.1161/CIRCULATIONAHA.105.592899. PubMed DOI

Yang SG, Mlcek M, Kittnar O. Gender Differences in Electrophysiological Characteristics of Idiopathic Ventricular Tachycardia Originating From Right Ventricular Outflow Tract. Physiol Res. 2014;63(Suppl 4):S451–458. doi: 10.33549/physiolres.932920. PubMed DOI

Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers for right ventricular outflow tract tachycardia. Am Heart J. 2000;139:1009–1013. doi: 10.1067/mhj.2000.106164. PubMed DOI

Sacher F, Meregalli P, Veltmann C, Field ME, Solnon A, Bru P, Abbey S, Jaïs P, Tan HL, Wolpert C, Lande G, Bertault V, Derval N, Babuty D, Lacroix D, Boveda S, Maury P, Hocini M, Clémenty J, Mabo P, Lemarec H, Mansourati J, Borggrefe M, Wilde A, Haïssaguerre M, Probst V. Are women with severely symptomatic brugada syndrome different from men? J Cardiovasc Electrophysiol. 2008;19:1181–1185. doi: 10.1111/j.1540-8167.2008.01223.x. PubMed DOI

Albert CM, McGovern BA, Newell JB, Ruskin JN. Sex differences in cardiac arrest survivors. Circulation. 1996;93:1170–1176. doi: 10.1161/01.CIR.93.6.1170. PubMed DOI

Lerner DJ, Kannel WB. Patterns of coronary artery heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J. 1986;111:383–390. doi: 10.1016/0002-8703(86)90155-9. PubMed DOI

Haigney MC, Zareba W, Nasir JM, et al. MADIT II Investigators. Gender differences and risk of ventricular tachycardia or ventricular fibrillation. Heart Rhythm. 2009;6:180–186. doi: 10.1016/j.hrthm.2008.10.045. PubMed DOI

Svorc P, Svorc P., Jr General Anesthesia and Electrocardiographic Parameters in in vivo experiments involving rats. Physiol Res. 2022;71:177–192. doi: 10.33549/physiolres.934848. PubMed DOI PMC

GPER-1 Rapid Regulation Influences p-Akt Expression to Resist Stress-Induced Injuries in a Sex-Specific Manner