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

Sorin Stefan 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.
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