The Effect of Sex on Ventricular Arrhythmic Events in Patients with Congestive Heart Failure

Aronson, Doron; Burger, Andrew J.

doi:10.1046/j.1460-9592.2002.01206.x

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…The presence of non-ischaemic cardiomyopathy is associated with a lower overall mortality when compared to patients with ischaemic cardiomyopathy. 1 , 15 , 17 , 24 , 25 It can also not be ruled out that there is a bias in that physicians tend to withhold ICD-therapy from women with worse prognosis. An additional factor may be that women in general have a longer life expectancy than men.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries

et al. 2017

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AimsTherapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials.Methods and resultsRetrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16–55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value < 0.0001). An appropriate ICD shock occurred in 66 women (8%) and 514 men (14%; HR 0.61; 95% CI: 0.47–0.79; P = 0.0002).ConclusionOur retrospective analysis of 14 local registries in 11 European countries demonstrates that fewer women than men undergo ICD implantation for primary prevention. After multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.

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Section: Discussionmentioning

confidence: 99%

Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries

et al. 2017

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“…Saba et al (22) found that in female mice, estrogen prolongs atrioventricular nodal conduction and the right ventricular effective refractory period. In contrast, Aronson and Burger (23) found that complex ventricular ectopy and episodes of ventricular tachycardia are significantly lower in women. However, this was not a surgical series; therefore, patients were not exposed to all of the potential triggering factors that act exclusively as a consequence of surgery.…”

Section: Discussionmentioning

confidence: 85%

Predictors of new malignant ventricular arrhythmias after coronary surgery

Ascione

Reeves

Santo

et al. 2004

Journal of the American College of Cardiology

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“…The underlying causes for the more favorable arrhythmic profile of women are not entirely clear but may be related to the lower propensity to sustained ventricular tachycardia in the nonischemic heart failure setting 15,16 but also for ischemic cardiomyopathy-associated sudden cardiac death. [17][18][19] In our sample, despite having more women with nonischemic cardiomyopathy, the overall reduction in arrhythmic burden was still present even after adjustment for baseline differences.…”

Section: Discussionmentioning

confidence: 99%

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

Providência

Marijon

Lambiase

et al. 2016

JAHA

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BackgroundThere are limited data describing sex specificities regarding implantable cardioverter defibrillators (ICDs) in the real‐world European setting.Methods and ResultsUsing a large multicenter cohort of consecutive patients referred for ICD implantation for primary prevention (2002–2012), in ischemic and nonischemic cardiomyopathy, we examined the sex differences in subjects' characteristics and outcomes. Of 5539 patients, only 837 (15.1%) were women and 53.8% received cardiac resynchronization therapy. Compared to men, women presented a significantly higher proportion of nonischemic cardiomyopathy (60.2% versus 36.2%, P<0.001), wider QRS complex width (QRS >120 ms: 74.6% versus 68.5%, P=0.003), higher New York Heart Association functional class (≥III in 54.2%♀ versus 47.8%♂, P=0.014), and lower prevalence of atrial fibrillation (18.7% versus 24.9%, P<0.001). During a 16 786 patient‐years follow‐up, overall, fewer appropriate therapies were observed in women (hazard ratio=0.59, 95% CI 0.45–0.76; P<0.001). By contrast, no sex‐specific interaction was observed for inappropriate shocks (odds ratio ♀=0.84, 95% CI 0.50–1.39, P=0.492), early complications (odds ratio=1.00, 95% CI 0.75–1.32, P=0.992), and all‐cause mortality (hazard ratio=0.87 95% CI 0.66–1.15, P=0.324). Analysis of sex‐by‐ cardiac resynchronization therapy interaction shows than female cardiac resynchronization therapy recipients experienced fewer appropriate therapies than men (hazard ratio=0.62, 95% CI 0.50–0.77; P<0.001) and lower mortality (hazard ratio=0.68, 95% CI 0.47–0.97; P=0.034).ConclusionsIn our real‐life registry, women account for the minority of ICD recipients and presented with a different clinical profile. Whereas female cardiac resynchronization therapy recipients had a lower incidence of appropriate ICD therapies and all‐cause death than their male counterparts, the observed rates of inappropriate shocks and early complications in all ICD recipients were comparable.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT01992458.

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The Effect of Sex on Ventricular Arrhythmic Events in Patients with Congestive Heart Failure

Cited by 12 publications

References 32 publications

Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries

Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries

Predictors of new malignant ventricular arrhythmias after coronary surgery

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

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