Sex-specific triggers for right ventricular outflow tract tachycardia

Background Right ventricular outflow tract tachycardia (RVOT-VT) is a commo n arrhythmia in young patients without heart disease. The arrhythmia is cha racterized by repetitive bursts and premature ventricular contractions with a left bundle branch block, inferior-axis QRS morphology, and symptoms of palpitations. Although more frequent in women, sex-specific triggers for sy mptomatic RVOT-VT have not been identified. Methods and Results We interviewed 34 women and 13 men referred for ablatio n of RVOT-VT to determine if predictable but sex-specific exacerbations in symptomatic RVOT-VT exist. After a general query asking if there was predic tability to what triggered palpitations, we then specifically queried all p atients about symptomatic RVOT-VT initiation with exercise, stress, caffein e, fatigue, and, in women only, periods of recognized hormonal flux. The ti mes identified as states of hormonal flux included premenstrual, gestationa l, perimenopausal, and coincident with the administration of birth control pills. In response to the completed interview, the most common recorded tri gger for RVOT-VT in women was recognized states of hormonal flux with 20 (5 9%) of 34 women responding positively and 14 (41%) of the 34 indicating tha t states of hormonal flux were the only recognizable triggers. Men were mor e likely than women to report that their RVOT-VT was predictably triggered by exercise, stress, or caffeine: 12 (92%) of 13 men versus 14 (41%) of 34 women (P <.01). Conclusions Triggers for RVOT-VT initiation are sex specific. Women have RV OT-VT initiation with recognized states of hormonal flux. Men more commonly have RVOT-VT initiated by exercise or stress. These data have important im plications related to patient education and counseling in the setting of RV OT-VT and may influence the timing of drug treatment and electrophysiologic evaluation in selected patients.