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Multicenter Study
. 2021 Jun;7(6):705-715.
doi: 10.1016/j.jacep.2020.10.009. Epub 2020 Dec 24.

Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients

Aurelio Quesada  1 , Francisco Arteaga  2 , Rafael Romero-Villafranca  3 , Luisa Perez-Alvarez  4 , José Martinez-Ferrer  5 , Javier Alzueta-Rodriguez  6 , Joaquín Fernández de la Concha  7 , Juan G Martinez  8 , Xavier Viñolas  9 , Jose M Porres  10 , Ignasi Anguera  11 , Rosa Porro-Fernández  12 , Blanca Quesada-Ocete  13 , Fernando de la Guía-Galipienso  14 , Victor Palanca  15 , Javier Jimenez  15 , Javier Quesada-Ocete  16 , Fabian Sanchis-Gomar  17 ; UMBRELLA Research Group
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Free article
Multicenter Study

Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients

Aurelio Quesada et al. JACC Clin Electrophysiol. 2021 Jun.
Free article

Abstract

Objectives: The study goal was to examine whether there are sex-related differences in the incidence of ventricular arrhythmias and mortality in CRT-defibrillator (CRT-D) recipients.

Background: Few studies have evaluated sex-related benefits of cardiac resynchronization therapy (CRT). Moreover, data on sex-related differences in the occurrence of ventricular tachyarrhythmias in this population are limited.

Methods: A multicenter retrospective study was conducted in 460 patients (355 male subjects and 105 female subjects) from the UMBRELLA (Incidence of Arrhythmia in Spanish Population With a Medtronic Implantable Cardiac Defibrillator Implant) national registry. Patients were followed up through remote monitoring after the first implantation of a CRT-D during a median follow-up of 2.2 ± 1.0 years. Sex differences were analyzed in terms of ventricular arrhythmia-treated incidence and death during the follow-up period, with a particular focus on primary prevention patients.

Results: Baseline New York Heart Association functional class was worse in women compared with that in men (67.0% of women in New York Heart Association functional class III vs. 49.7% of men; p = 0.003), whereas women had less ischemic cardiac disease (20.8% vs. 41.7%; p < 0.001). Female sex was an independent predictor of ventricular arrhythmias (hazard ratio: 0.40; 95% confidence interval: 0.19 to 0.86; p = 0.020), as well as left ventricular ejection fraction and nonischemic cardiomyopathy. Mortality in women was one-half that of men, although events were scarce and without significant differences (2.9% vs. 5.6%; p = 0.25).

Conclusions: Women with left bundle branch block and implanted CRT have a lower rate of ventricular tachyarrhythmias than men. All-cause mortality in patients is, at least, similar between female and male subjects.

Keywords: cardiac resynchronization therapy; heart failure; mortality; sex; ventricular tachyarrhythmia.

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Conflict of interest statement

FUNDING SUPPORT AND AUTHOR DISCLOSURES The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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