The influence of sex and age on ventricular arrhythmia in a population-based registry

Styles, K.; Sapp, John L.; Gardner, Martin J.; Gray, Christopher; AbdelWahab, Amir; MacIntyre, Ciorsti; Gao, Dongsheng; Alharbi, Mousa; Doucette, Steve; Theriault, Chris; Parkash, Ratika

doi:10.1016/j.ijcard.2017.06.041

Cited by 9 publications

(10 citation statements)

References 36 publications

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“…Several studies are reporting a comparable risk of death between the two groups, whereas others are in line with the current study, reporting a lower risk of death in women. 3 , 5 , 6 , 17 , 25 The lower mortality in women is an interesting finding, as the aforementioned studies are consistently reporting a more severe stage of heart failure in women. A sub‐study of the SCD‐HeFT demonstrated no difference in mortality between ICD‐treated and placebo‐treated women (risk of death 19% vs. 21%, respectively), indicating a low incidence of arrhythmic deaths in women.…”

Section: Discussionmentioning

confidence: 88%

“…Our data were consistent with previous studies showing that men receive more ADT compared with women. 3 , 5 , 6 , 17 There are studies suggesting that prophylactic ICD implantation may be of smaller benefit in female patients. A meta‐analysis including primary prevention ICD randomized trials showed that ICD implantation in women was not associated with an increase in survival, contrary to men who showed a 25% reduction in mortality.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 Moreover, studies focusing on the benefit of ICD therapy have often shown that male sex itself is a risk factor for occurrence of lethal arrhythmias. 3 , 4 , 5 , 6 Data regarding sex‐specific differences in risk stratification of ventricular arrhythmias are scarce. There is some evidence that certain characteristics in women, such as older age, increase the risk of SCD.…”

Section: Introductionmentioning

confidence: 99%

“…There is some evidence that certain characteristics in women, such as older age, increase the risk of SCD. 6 , 7 , 8 The mechanism of this interaction is not fully understood, but alterations in hormonal status or delayed onset of coronary artery disease (CAD) are suggested to affect susceptibility for SCD in older women. 9 , 10 In addition, studies evaluating cardiac arrest survivors have shown that left ventricular (LV) dysfunction is an important substrate for SCD in men, but less so in women.…”

Section: Introductionmentioning

confidence: 99%

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Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients

et al. 2021

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Aims Risk stratification models of sudden cardiac death (SCD) are based on the assumption that risk factors of SCD affect risk to a similar extent in both sexes. The aim of the study is to evaluate differences in clinical outcomes between sexes and evaluate whether risk factors associated with appropriate device therapy (ADT) differ between men and women. Methods and resultsWe performed a cohort study of implantable cardioverter defibrillator (ICD) patients referred for primary or secondary prevention of SCD between 2009 and 2018. Multivariable Cox regression models for prediction of ADT were constructed for men and women separately. Of 2300 included patients, 571 (25%) were women. Median follow-up was 4.6 (inter-quartile range: 4.4-4.9) years. Time to ADT was shorter for men compared with women [hazard ratio (HR) 1.71, P < 0.001], as was time to mortality (HR 1.37, P = 0.003). In women, only secondary prevention ICD therapy (HR 1.82, P < 0.01) was associated with ADT, whereas higher age (HR 1.20, P < 0.001), absence of left bundle branch block (HR 0.72, P = 0.01), and secondary prevention therapy (HR 1.80, P < 0.001) were independently associated with ADT in men. None of the observed parameters showed a distinctive sex-specific pattern in ADT. Conclusions Male ICD patients were at higher risk of ADT and death compared with female ICD patients, irrespective of an ischaemic or non-ischaemic underlying cardiomyopathy. Our study highlights the importance to stratify outcomes of ICD trials by sex, as study results differ between men and women. However, none of the available clinical parameters showed a clear sex-specific relation to ventricular arrhythmias. As a consequence, sex-specific risk stratification models of SCD using commonly available clinical parameters could not be derived.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients

et al. 2021

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“…Incidence of different cardiovascular pathologies and their clinical manifestations are well known to differ between women and men. In cardiac electrophysiology, this includes less frequent ventricular fibrillation [1] and more frequent torsade de pointes [2] in pre-menopausal women. Important studies investigated sex differences in electrophysiologic background, mainly concentrating on ventricular repolarisation [[3], [4], [5]].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in heart rate responses to postural provocations

Hnatkova

Šišáková

Smetana

et al. 2019

International Journal of Cardiology

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Sex differences are known in several facets of cardiac electrophysiology, mostly concerning myocardial repolarisation. In this study, heart rate and heart rate variability (HRV) responses to postural provocations were compared in 175 and 176 healthy females and males, respectively (aged 33.1 ± 9.1 years). Two different postural provocative tests with position changes supine→sitting→standing→supine and supine→standing→sitting→supine (15-min standing, 10-min other positions) were performed up to 4 times in each subject. Heart rate and heart rate variability spectral indices were measured in 5-min windows before positional changes. At supine position, females had averaged heart rate approximately 5 beats per minute (bpm) faster than males and this sex difference was practically constant during the postural changes. In both sexes, change supine→sitting and supine→standing increased heart rate by approximately 10 and 30 bpm, respectively, with no statistical differences between the sex groups. At supine baseline, females had normalised high frequency components (nHF) of HRV approximately 7% larger compared to males (p < 0.001). While the same difference in nHF was found at sitting, the change to standing position lead to significantly larger nHF reduction in females compared to males (mean changes 22.5 vs 17.2%, p < 0.001). This shows that despite similar heart rate increase, females respond to standing by more substantial shifts in cardiac sympatho-vagal modulations. This makes it plausible to speculate that the differences in autonomic reactions to stress contribute to the known sex-differences in psychosocial responses to stressful situations and to the known difference in susceptibility to ventricular fibrillation between females and males.

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Autonomic responses to postural provocations

Hnatkova

Malik

2020

Sex and Cardiac Electrophysiology

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The influence of sex and age on ventricular arrhythmia in a population-based registry

Cited by 9 publications

References 36 publications

Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients

Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients

Sex differences in heart rate responses to postural provocations

Autonomic responses to postural provocations

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