Gender matters! Impact of gender on the utilization of defibrillators with cardiac resynchronisation therapy and outcome: results from the German DEVICE registry

Clin Res Cardiol (2024). DOI 10.1007/s00392-024-02406-5
S. S. Popescu (Lübeck)¹, A. Gasperetti (Milano)², J. Brachmann (Coburg)³, L. Eckardt (Münster)⁴, K.-H. Kuck (Hamburg)⁵, S. Willems (Hamburg)⁶, P. Lugenbiel (Heidelberg)⁷, I. Akin (Mannheim)⁸, C. Meyer (Düsseldorf)⁹, S. Schneider (Ludwigshafen am Rhein)¹⁰, M. Hochadel (Ludwigshafen am Rhein)¹¹, J. Senges (Ludwigshafen am Rhein)¹², R. R. Tilz (Lübeck)^1
1Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; ²IRCCS Cardiologico Monzino Department of Cardiology Milano, Italien; ³Medical School / Regiomed GmbH Coburg, Deutschland; ⁴Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; ⁵LANS Cardio Hamburg Kardiologie Hamburg, Deutschland; ⁶Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; ⁷Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; ⁸Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; ⁹Evangelisches Krankenhaus Düsseldorf Klinik für Kardiologie Düsseldorf, Deutschland; ¹⁰IHF GmbH Ludwigshafen am Rhein, Deutschland; ¹¹IHF GmbH Statistik Ludwigshafen am Rhein, Deutschland; ¹²Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein, Deutschland

Background: Defibrillators with cardiac resynchronisation therapy (CRT-Ds) are widely used in patients with left ventricular (LV) systolic dysfunction and high-grade intraventricular conduction delays. Real world data regarding the impact of gender on CRT-D implantation and outcome are scarce.

Purpose: To determine the impact of gender on the CRT-D devices implantation and outcome.

Methods: The German DEVICE registry is a prospective, nationwide database of implantable cardioverter-defibrillators (ICD) and CRT devices implantations and revisions. A total of 1536 patients undergoing CRT-D implantations and revisions were included between March 2007 and February 2014 in 44 centres and monitored for a median of 17.2 months. Herein we conducted the gender-based analysis of the CRT-D recipients. 

Results: Only a minority of the patients in this registry was females (329; 21.4%). The demographic data (age and BMI) were similar between genders. The female population was less likely to have a coronary heart disease (35.3% vs. 56.7%; p<0.001), but more likely to have dilated cardiomyopathy (61.1% vs. 49.5%; p<0.001). Significantly less women had a LVEF ≤35% (90.6% vs. 94.8%, p=0.005). A total of 84.2% of females and 80.2% of males received a device for the primary prevention of the sudden cardiac death (SCD; p=0.1). Women were more likely to have a history of ventricular fibrillation (44.2% vs. 23.0%, p=0.002) and resuscitation (p=0.01), but less likely to have a history of ventricular tachycardia (p=0.019). Significantly more women than men showed a left bundle branch block at implantation (89.7% vs. 80.9%, p<0.001). A QRS duration of at ≥ 150 ms was noted in 74.8% of women and 71.5% of men (p=0.25), while significantly more women had a QRS of ≥ 120 ms (97.0% vs. 94.2%; p=0.043). The overall incidence of major periprocedural complications and in hospital complications was similar between groups (3.6% vs 2.4%, p=0.25 and 6.0% vs. 5.8%, p=0.88 respectively), however a pneumothorax requiring intervention was more common among women (1.8% vs. 0.5%, p=0.027). The rate of device revision until discharge and the in-hospital mortality did not differ between genders. The Kaplan-Meier estimated 1-year all-cause mortality was 6.3% for women and 8.2% for men (p=0.25), while the estimated incidence of death or defibrillator shocks was 11.0% and 15.1%, respectively (p=0.051). The non-lethal complications and device revisions during follow-up (FU) were similar between genders. Women showed a lower non-device-dependent cardiovascular hospitalisation rate (8.2% vs. 13.1%; p=0.043). Women had more fear of receiving a device shock than men (p=0.002).

Conclusions: In this real-life CRT-D patient cohort only a minority of patients was female. Women had a higher rate of pneumothorax requiring intervention. The 1-year mortality and the complications during FU were similar between genders. Women had a lower rate of non-device-dependent cardiovascular hospitalisation during FU.