Sex hormones and arrhythmia risk in women with long QT syndrome.

Sex-related differences in the QT interval become evident from puberty to menopause. Sex steroid hormones have been suggested to play a role in cardiac repolarization, though their impact remains a matter of debate. These effects are especially pronounced in women with inherited long QT syndrome (LQTS) and may face a higher risk of QT variability associated with endogenous or exogenous hormonal fluctuations. This narrative review aimed to summarize the impact of physiological hormonal fluctuations on QT interval in women with LQTS across the female lifespan, including menstrual cycle, pregnancy and postpartum, and menopause, concluding with exogenous hormonal administration such as oral contraceptives and ovarian stimulation in assisted reproductive technologies, highlighting potential genotype-specific differences. Insights gained from this review may inform more precise risk stratification, optimize individualized management, and improve safety for women with LQTS across their reproductive lifespan.