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Atrial Fibrillation: The Difference Between Men and Women


Kelli Miller, ELS

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The adult heart typically beats about 60-100 times a minute when you are calm, relaxed and not exercising. Your heart beats, or pulses, when it squeezes tightly to move blood in and out of the heart. Any change in the normal beating pattern (called your heart rhythm) may lead to serious health problems.  

The most common type of irregular heart rhythm is atrial fibrillation (AF, or afib). It's called "atrial" fibrillation because it starts in the upper chambers of the heart, called the atria.

Both men and women can get afib. But your symptoms, diagnosis, treatment and outcome may differ, depending on your gender. A 2013 study noted significant differences among men and women with afib. Reasons for this might include:    

  • A misbelief that heart disease affects only white, middle-aged men

  • Biological differences scientists are still investigating

Following are some important things you need to know about gender differences in AF.

Who Gets Afib?

Atrial fibrillation is more common in men. However, after age 75, most people newly diagnosed with afib are women. Doctors say this is likely because women simply live longer than men. And men with afib are usually diagnosed at a younger age than women. Things that increase everyone's risk for afib are:

  • Aging

  • Diabetes

  • High blood pressure (hypertension)

The root cause of afib appears to differ between men and women.

  • In women, it is usually due to a problem with the heart valves.

  • In men, it is usually a result of coronary artery disease (CAD).

Different Symptoms

People with afib have fast, fluttering heart beats, called palpitations. Some describe it as a flip-flopping feeling or "butterflies" in the chest. Women are more likely than men to feel such symptoms. Doctors think this is because women have a faster heartbeat in general. Also, a woman's body frame is typically smaller than a man's, so it may be easier to feel the heart speed up and quiver. 

Afib symptoms more common in women than men are:

  • Faster heart rate

  • Fatigue and trouble sleeping

  • Longer fluttering episodes

  • Weakness

Different Co-existing Conditions

Men with afib are more likely to have coronary artery disease (CAD) or a lung disease called chronic obstructive pulmonary disease (COPD).

Women who seek hospital care for afib symptoms are significantly more likely to have a thyroid problem (that is not causing the irregular heartbeats).  Other conditions that have been seen more often in women than men with afib are:

  • Depression

  • High blood pressure (hypertension)

  • Kidney problems

  • Obesity (body mass index greater or equal to 30)

Complication Differences

Afib increases your risk of having a stroke. The abnormal heart rhythm makes it hard for the upper chambers of the heart to push out blood. Blood can pool inside the heart and form a clot that can break off, enter the circulation, and block blood flow.

Women with afib are more likely than men to have a stroke or early death. They also have higher rates of heart attack and congestive heart failure. In general, men with afib usually have a better outcome than women.

Treatment Differences

Anticoagulants, such as warfarin or aspirin, are drugs used to thin the blood. They are given to afib patients to help prevent blood clots from forming in the heart.  Studies show clot-preventing medicines are prescribed more often to men with afib than women. (However, women with afib who take anticoagulants have a greater risk of dangerous bleeding episodes.) 

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Nov 18, 2016

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Medical References

  1. Gurevitz OT, Varadachari CJ, Ammash NM, et al. The effect of patient sex on recurrence of atrial fibrillation following successful direct current cardioversion. Am Heart J. 2006 Jul;152(1):155.e9-13.
  2. Her Heart Matters: What Women Need to Know About Afib and Stroke. WomenHeart: The National Coalition for Women with Heart Disease.
  3. James AF, Hancox JC. Sex, drugs and arrhythmia: are gender differences in risk of torsades de pointes simply a matter of testosterone? Cardiovasc Res. 2003 Jan;57(1):1-4.
  4. Kerr CR, Humphries K. Gender-Related Differences in Atrial Fibrillation. J Am Coll Cardiol. 2005;46(7):1307-8.
  5. Women & Abnormal Heart Beats. The Cleveland Clinic.
  6. Wolbrette D, Naccarelli G, Curtis A, Lehmann M, Kadish A. Gender Differences in Arrhythmias. Clin Cardiol. 2002 Feb;25(2):49-56.
  7. What is Atrial Fibrillation? American Heart Association.
  8. Volgman AS, Manankil MF, Mookherjee D, Trohman RG. Women with atrial fibrillation: Greater risk, less attention. Gend Med. 2009 Sep;6(3):419-32.
  9. What is Atrial Fibrillation? National Heart, Lung, and Blood Institute.
  10. Ball J, Carrington MJ, Wood KA, Stevens S. Women Versus Men with Chronic Atrial Fibrillation: Insights from the Standard Versus Atrial Fibrillation spEcific managemenT studY (SAFETY). PLoSOne. 2013; May 29;8(5):e65795.
  11. How the Heart Works. American College of Cardiology: Cardiosmart.

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