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The difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Interestingly, cardiovascular structural and electrophysiological remodelling promoted by exercise training enhances this 'gender effect'. Despite all these relevant issues, we lack gender specific recommendations in the current guidelines for electrical therapies for heart rhythm disorders and heart failure. Even more, we continue to see that fewer women are included in clinical trials and are less referred than men for these treatments.

Giustetto et al .1 have reported the largest available study of patients affected by short QT syndrome, an extremely rare genetic ion channel disease that has only recently been identified and described.2,3 The results of this multicentre study reinforce concepts gleaned from previous reports. Short QT syndrome is a genetic arrhythmogenic disease with a high risk of both syncope and sudden death throughout life. The study was based on data from 25 patients belonging to eight affected families, plus a further four sporadic cases. Although syncopes were reported, cardiac arrest was the most common event and often prompted the initial diagnosis of short QT syndrome. Notably, sudden death events occurred in the first year of life, as well as in adolescent age and adulthood. Moreover, other cases of sudden death were traced in apparently healthy family members (usually younger than 40 years) for whom no ECG was available. Thus, this new study reinforces the concept that sudden death is the most relevant clinical manifestation of short QT syndrome and that these events may occur in infants and other children. Short QT syndrome is now included among the set of arrhythmogenic diseases that can lead to sudden death during infancy and childhood ( Table 1 ). In all these diseases, an implantable cardioverter-defibrillator (ICD) is currently proposed for prevention of sudden death in high-risk patients.4 In most of the diseases (those with purely electrical abnormalities and otherwise normal systolic ventricular function), sudden death due to ventricular tachyarrhythmias is the dominant cause of premature death and alone accounts for almost all the difference in life expectancy … *Corresponding author. Tel: +390 51349858; fax: +390 51344859. E-mail address : cardio1{at}med.unibo.it