Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women—Data From a Multicenter French Registry

Providência, Rui; Marijon, Éloi; Lambiase, Pier D.; Bouzeman, Abdeslam; Defaye, Pascal; Klug, Didier; Amet, Denis; Perier, Marie‐Cécile; Gras, Daniel; Algalarrondo, Vincent; Deharo, Jean‐Claude; Leclercq, Christophe; Fauchier, Laurent; Babuty, Dominique; Bordachar, Pierre; Sadoul, Nicolas; Piot, Olivier; Boveda, Serge; Providência, Rui; Beganton, Frankie

doi:10.1161/jaha.115.002756

Cited by 52 publications

(52 citation statements)

References 39 publications

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“…In a large multicentre French registry, women who had ICD implantation for primary prevention had a significantly lower likelihood of receiving appropriate ICD therapies (17.4% vs 23%, P<0.001) but had similar mortality compared with men (HR=0.87, 95% CI 0.66 to 1.15, P=0.324) 21. There was no gender difference observed with inappropriate shocks (6.7% vs 6.7%, OR 1.0, 95% CI 0.74 to 1.35, P=0.997) 21. Similarly, Seegers et al 22 showed that women received 50% less appropriate ICD shocks than men (3.6% vs 6.3% per year, P=0.002), although both groups have similar mortality (P=0.08).…”

Section: Discussionmentioning

confidence: 99%

Gender differences in the use of primary prevention ICDs in New Zealand patients with heart failure

et al. 2018

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Objective Women have been under-represented in randomised clinical trials for primary prevention implantable cardioverter defibrillators (ICDs), and there are concerns about the efficacy of devices between genders. Our study aimed to investigate gender differences in the use of primary prevention ICD in patients with heart failure from the northern region of New Zealand. Methods Patients with heart failure with systolic dysfunction who received primary prevention ICD/cardiac resynchronisation therapy-defibrillator (CRT-D) in the northern region of New Zealand from 1 January 2007 to 1 June 2015 were included. Complications, mortality and hospitalisation events were reviewed. results Of the 385 patients with heart failure implanted with ICD/CRT-D, women comprised 15.1% (n=58), and no change in utilisation of these devices was observed over the study period among women. Women were more likely to have non-ischaemic cardiomyopathy and have higher perioperative complications (8.6% vs 2.5%, P=0.02), with non-significant higher trend towards increased lead displacement (5.2% vs 1.8%, P=0.12). Women appeared to have lower all-cause (10.3% vs 18.7%, P=0.12), cardiovascular (5.2% vs 11.9%, P=0.13) and heart failure (3.5% vs 7.9%, P=0.22) mortalities but was not statistically significant. There were no gender differences in all-cause (70.7% vs 67%, P=0.58) or heart failure (19% vs 25%, P=0.32) readmissions. Conclusion Perioperative complications were significantly more common in women referred for ICD/ CRT-D. Although there has been a significant increase in ICD implantation rates, gender differences in the use of these devices still exist in New Zealand, in keeping with the demographics of ischaemic heart disease and systolic dysfunction between genders.

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Section: Discussionmentioning

confidence: 99%

Gender differences in the use of primary prevention ICDs in New Zealand patients with heart failure

et al. 2018

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“…The remaining 5307 patients represent the study group—4037 (76.1%) received CRT-D (all primary prevention), while the remaining 1270 (23.9%) received CRT-P. Most patients from our cohort have been included and described in more detail in previous studies 5 6 8 9. Ischaemic cardiomyopathy was defined as the presence of systolic dysfunction associated with a history of myocardial infarction and/or the presence of significant coronary artery disease documented on a coronary angiogram.…”

Section: Methodsmentioning

confidence: 99%

“…In the Défibrillateur Automatique Implantable en Prévention Primaire (DAI-PP) registry8 and CeRtiTuDe cohort study,5 vital status data were obtained from the hospital or the general practitioner, and were systematically controlled through the National Institute of Statistics Economical Studies. Causes of death were obtained by the investigators and/or by the French Center on Medical Causes of Death (CepiDc–INSERM).…”

Section: Methodsmentioning

confidence: 99%

Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure

Barra

Providência

Duehmke

et al. 2017

Heart

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“…We further compared this cohort with a control group of 95 patients with pacing-induced cardiomyopathy and no history of sustained ventricular arrhythmias receiving an upgrade to CRT-D. The latter group was included in the DAI-PP study (Defibrillateur Automatique Implantable Prevention Primaire; NCT01992458) (13). We hypothesised that patients with pacing-induced cardiomyopathy could be safely upgraded to a CRT-P device only.…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, this was a registry on 5,539 patients implanted with an ICD (with or without CRT) in the setting of primary prevention in 12 French centers (13). Our control group included all patients with no history of coronary artery disease or any underlying cardiomyopathy who had an upgrade of pacemaker to CRT-D due to LV systolic function deterioration deemed to be the result of chronic RV pacing.…”

Section: Patients' Eligibility Criteria Procedural Details and Follomentioning

confidence: 99%

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

et al. 2016

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Aims: Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which those patients would also benefit from defibrillator back-up at the time of CRT upgrade is, however, unknown. Methods:Retrospective observational cohort study of 199 patients with pacing-induced cardiomyopathy (without history of sustained ventricular arrhythmia), including 104 upgraded to CRT-Pacemaker (CRT-P) and 95 upgraded to CRT-Defibrillator (CRT-D). The incidence of ventricular arrhythmias and, through a cause-of-death analysis based on clinical data and necropsy results, the risk of sudden arrhythmic death were assessed and compared between the two groups.Results: During a mean follow-up of 66±24 months, 40 (38.5%) CRT-P patients died: three from primary arrhythmic death, while the remaining died of different causes (especially progressive heart failure), giving an incidence of 6.2 sudden arrhythmic deaths per 1000 patient-years. No episode of sustained VT was observed in the study group. There were no sudden arrhythmic deaths in the CRT-D group during a shorter follow-up, but the small and non-significant difference in all-cause mortality between CRT-P and CRT-D groups was mostly accounted for by an increase in non-sudden death. Women upgraded to CRT were at particularly low risk of all-cause mortality compared with men (HR 0.232, p=0.048). Conclusion:Our findings suggest that patients who develop pacing-induced cardiomyopathy and are upgraded to CRT may not derive any significant benefit from the addition of the defibrillator in the absence of a history of ventricular arrhythmias. 3 KEYWORDSCardiac resynchronization therapy; pacemaker; implantable cardioverter-defibrillator; ventricular arrhythmias; cause-of-death; sudden arrhythmic death. 4 CONDENSED ABSTRACTIn our retrospective cohort study of 199 patients with pacing induced cardiomyopathy submitted to CRT upgrade, we have found that the risk of sustained ventricular tachycardia or sudden arrhythmic death is very low, and any increased mortality risk in those receiving CRT-P compared with CRT-D is mostly accounted for by an increase in non-sudden death. 5 WHAT'S NEW? Our study provides the largest and longest-term cause-of-death analysis in patients with pacing-induced cardiomyopathy based on post-mortem examinations and death certificates. We have found that the annual risk of sudden arrhythmic death or sustained ventricular arrhythmias in these patients is very low, and similar to a control group implanted with CRT with a defibrillator.  The small difference in all-cause mortality between CRT-Pacemaker and CRTDefibrillator in patients with pacing-induced cardiomyopathy is mostly accounted for by an increase in non-sudden death. Our results suggest that an upgrade to CRT-Defibrillator in patients with pacinginduced cardiomyopathy may convey no additional benefit when compared with upgrade to CRT-Pacemaker, and the cost-effectiveness ratio of...

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Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women—Data From a Multicenter French Registry

Cited by 52 publications

References 39 publications

Gender differences in the use of primary prevention ICDs in New Zealand patients with heart failure

Gender differences in the use of primary prevention ICDs in New Zealand patients with heart failure

Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

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