Gender Differences in Procedure-Related Adverse Events in Patients Receiving Implantable Cardioverter-Defibrillator Therapy

Peterson, Pamela N.; Daugherty, Stacie L.; Wang, Yongfei; Vidaillet, Humberto; Heidenreich, Paul A.; Curtis, Jeptha P.; Masoudi, Frederick A.

doi:10.1161/circulationaha.108.793463

Cited by 177 publications

(117 citation statements)

References 31 publications

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“…Reports from large multicentre registries with predominantly patients with ischemic heart dis ease demonstrated an early complication rate varying from 3.3% to 11% during the hospital admission for ICD implantation (41,42). In the present study, the rates of infection, lead displacement and malfunction were not uncommon, with annual rates of 1.1%, 1.3% and 1.4%, respectively.…”

Section: Discussionsupporting

confidence: 46%

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Wang¹,

Xie²,

Tjahjono³

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Since the introduction of the implantable cardioverter-defibrillator (ICD) in patients with hypertrophic cardiomyopathy (HCM), the incidence of sudden cardiac death (SCD) has been significantly reduced. Given its widespread use, it is important to identify the outcomes associated with ICD use in patients with HCM. The present paper is a systematic review and meta-analysis of the rates of appropriate and inappropriate interventions, mortality, and device complications in HCM patients with an ICD.Methods: We conducted a systematic review and meta-analysis on 27 studies reporting outcomes and complications after ICD implantation in patients with HCM. ICD interventions, device complications, and mortality were extracted for analysis.Results: A total of 3,797 patients with HCM and ICD implantation were included (mean age, 44.5 years; 63% male), of which 83% of patients had an ICD for primary prevention of SCD. The cardiac mortality was 0.9% (95% CI: 0.7-1.3) per year and non-cardiac mortality was 0.8% (95% CI: 0.6-1.2) per year. Annualized appropriate intervention rate was 4.8% and annualized inappropriate intervention was 4.9%. The annual incidence of lead malfunction, lead displacement and infection was 1.4%, 1.3%, and 1.1%, respectively.Conclusions: ICD use in patients with HCM produces low rates of cardiac and non-cardiac mortality, and an appropriate intervention rate of 4.8% per year. However, moderate rates of inappropriate intervention and device complications warrant careful patient selection in order to optimize the risk to benefit ratio in this select group of patients.

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Section: Discussionsupporting

confidence: 46%

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Wang¹,

Xie²,

Tjahjono³

et al. 2017

Ann. Cardiothorac. Surg.

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“…35 In addition to women's older age and co-morbidities, smaller body size of females and a more challenging implantation procedure due to thinner right ventricular wall, smaller blood vessel diameter and a higher prevalence of anatomical variations in venoarterial relationships may explain such findings. 21,[35][36][37][38] On the other side, female gender seems associated with a better outcome after pacemaker placement, with males experiencing poorer survival following pacemaker implantation. 30,39 In conclusion, despite presenting to pacemaker implantation older, more symptomatic, with more co-morbidities, and experiencing more procedure-related complications, females seem to obtain a greater benefit from pacemaker implantation than males, with a lower long-term mortality.…”

Section: Permanent Pacemakersmentioning

confidence: 99%

Outcomes in Women Undergoing Electrophysiological Procedures

Biase

Basile

Al‐Ahmad

2013

Arrhythmia &Amp; Electrophysiology Review

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The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

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“…On the contrary, no gender differences for pacemaker implantation have been documented in an Italian study (Boccia et al, 2005). A study from The Netherlands evaluating 33,564 patients demonstrated no gender differences in pacemaker selection, but a considerable drop in dual-chamber implantation with increasing age (Roeters et al, 2000). Another single centre study evaluating 259 patients found no significant difference in pacemaker mode selection between male and female patients (Veerareddy et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences

Singh¹,

Srivastava²,

Sethi³

et al. 2015

J App Pharm Sci

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Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

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Gender Differences in Procedure-Related Adverse Events in Patients Receiving Implantable Cardioverter-Defibrillator Therapy

Cited by 177 publications

References 31 publications

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Outcomes in Women Undergoing Electrophysiological Procedures

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences

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