Christine Tompkins, M.D., is a member of an exclusive group: Female physicians that study and treat the electrical disturbances of the heart. Of the more than 1,500 heart rhythm specialists in the country, only seven percent are women, according to the Heart Rhythm Society. An assistant professor in the Department of Cardiology, she is just the second female electrophysiologist to practice at the University of Rochester Medical Center.
Not only is Tompkins one of the few women in the field, but her research focuses on arrhythmias, or irregular heartbeats, 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.
At the Heart Rhythm Society’s annual scientific sessions in Boston this week, Tompkins presented 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’s suffered a heart attack.
The research, conducted in close collaboration with scientists in the Medical Center’s Heart Research Follow-Up Program, showed that women with weakened hearts due to the buildup of plaque in the arteries that supply blood and oxygen to the heart – a condition called ischemic cardiomyopathy – were at lower risk of arrhythmias than men with the same condition.
Tompkins’ team analyzed data from close to 1800 patients who participated in the MADIT-CRT trial, which was run by Rochester’s Arthur Moss, M.D..The two-year risk of arrhythmias was 13 percent for females with ischemic cardiomyopathy and 27 percent for males. They saw no difference in arrhythmias between men and women with non-ischemic cardiomyopathy, characterized by a weakened heart due to a viral illness, genetics or, in many cases, an unknown cause. All patients in the study had an implantable cardiac defibrillator or ICD, which detects irregular heartbeats and shocks the heart back into a normal rhythm.
Wojciech Zareba, M.D., Ph.D., professor of Cardiology and director of the Heart Research Follow-up Program at the Medical Center, says that focusing on cardiac arrhythmias in women is of great importance because women live longer than men. Data from the U.S. Census Bureau indicate that the life expectancy of women is five years longer than that of men – 80.5 compared to 75.5 years – and that there are five million more women than men above the age of 65.
“Investigating gender-related differences in the risk of arrhythmias will not only help improve the management of women, but will also help us understand why men are at higher risk,” said Zareba, a world expert on the research and treatment of heart rhythm disorders.
Earlier this year at the American College of Cardiology’s annual scientific sessions, Tompkins also presented research on the difference in inappropriate shocks experienced by women and men with ICDs. Though several major clinical trials have shown that ICDs reduce the risk of death in heart attack survivors and others with heart disease, one drawback is shocks delivered for causes other than potentially life-threatening arrhythmias. Such shocks are painful, psychologically disturbing and can decrease a patient’s quality of life.
Again analyzing data from Moss’ MADIT trials, Tompkins found women experience significantly less inappropriate shocks than men, partially explained by an increased frequency of atrial fibrillation – irregular rhythms in the two upper chambers of the heart – in men. Atrial fibrillation itself usually isn’t life threatening, but may wrongly trigger a shock from an ICD.
Recent data suggest that inappropriate ICD shocks may be associated with a higher risk of death, but Tompkins’ team didn’t identify any such risk in either gender. They found that appropriate shocks, on the other hand, were a strong predictor of death, with women showing a nearly two-fold higher risk than men during long-term follow-up.
“Women are less likely than men to get shocked erroneously, but when they experience an appropriate shock it is a worse sign,” said Tompkins. “We don’t know why this is the case, but the reasons are likely very complex and need further study.”
In the coming years Tompkins plans to build on these studies and hopes to establish a database with information from all the men and women who come to the Medical Center for the treatment of heart rhythm disorders. Other areas she’d like to investigate include the influence of estrogen and progesterone on arrhythmias in women and why women treated with anti-arrhythmic drugs for atrial fibrillation are more likely to develop a life-threatening arrhythmia known as polymorphic ventricular tachycardia or PMVT. Seventy percent of medication-induced PMVT occurs in women and doctors don’t fully understand why.
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 – Tompkins jumped in feet first after several years as an engineer. Electrophysiology encompasses a lot of engineering principles and being a physician provided two important things that Tompkins says her previous profession lacked – meaningful one-on-one interactions with people and the ability to help others.
Tompkins, who came to the Medical Center a year and a half ago after serving as chief fellow in cardiac electrophysiology at the Johns Hopkins Hospital, traces her interest in medicine back to volunteer work she did at Shriner’s Hospital for Children in Springfield, Massachusetts. She worked with children whose mothers had taken Thalidomide during pregnancy and had severe abnormalities in their limbs and bones as a result.
During her time in the engineering industry Tompkins missed the personal interactions, connections and fulfilling moments she experienced in the medical world. She recalls, “Towards the end of my time as an engineer I was designing spinal fusion cages for surgery and had to learn various surgical approaches. It finally occurred to me that I could be a better design engineer and comprehensively help others by going back to medical school.”
In addition to Tompkins and Zareba, Moss, Scott McNitt, Paul Wang, Slava Polonsky and Naila Choudhary from the University of Rochester Medical Center, James Daubert from Duke University Medical Center and Aysha Arshad from Valley Health System, Columbia University, contributed to the research.
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