Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;46(10):1153-1161.
doi: 10.1111/pace.14796. Epub 2023 Aug 28.

Sex-based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new-onset heart failure

Cecilia Rorsman  1   2 , Maiwand Farouq  1   3 , Sofia Marinko  1   3 , David Mörtsell  1   3 , Uzma Chaudhry  1   3 , Lingwei Wang  1   3 , Rasmus Borgquist  1   3
Affiliations

Sex-based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new-onset heart failure

Cecilia Rorsman et al. Pacing Clin Electrophysiol. 2023 Oct.

Abstract

Background: Patients with chronic right ventricular (RV) pacing are at an increased risk of heart failure. Previous studies have indicated that cardiac resynchronization therapy (CRT) is underused in this setting, and that there may be sex-based differences in both CRT use and clinical outcome.

Objective: To evaluate sex-based differences in CRT use and clinical outcome for patients with new-onset heart failure post RV pacing.

Methods: Data from the Swedish pacemaker registry was matched with data from the national death and disease registries. Patients with de novo pacemaker implant due to AV block during the period 2005-2020 were included. New-onset heart-failure within two years post-implant was evaluated, primary outcome was all-cause mortality.

Results: In all, 30183 patients (37% female) were included. Women were on average 3 years older, but had less comorbidities than men. Median follow-up time was 4.5 [2.0-8.0] years. Women had better age- and comorbidity-adjusted survival (HR 0.78 [0.73-0.84], p < .001). For the 3560 patients (12.4% men and 10.7% women, p < .001) who were diagnosed with new-onset heart failure, 5-year mortality was similar for men and women (50% vs. 48%, p = .29). However, women were less likely to receive CRT-upgrade (3.8% vs. 9.1%, p < .001), and those who did were almost ten years younger than the men.

Conclusion: Women with pacemaker due to AV block are older but have less comorbidities than men. They are less likely to develop new-onset heart failure, but also less likely to receive a CRT upgrade if they do develop heart failure. Increased awareness of the positive effects of CRT upgrade and potential sex- and age-based discrimination is warranted.

Keywords: cardiac resynchronization therapy; heart failure; pacemaker; prognosis.

PubMed Disclaimer

References

REFERENCES

    1. Somma V, Ha FJ, Palmer S, Mohamed U, Agarwal S. Pacing-induced cardiomyopathy: a systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm. 2023;20:282-290.
    1. Schwerg M, Dreger H, Poller WC, Dust B, Melzer C. Efficacy of optimal medical therapy and cardiac resynchronization therapy upgrade in patients with pacemaker-induced cardiomyopathy. J Interv Cardiac Electrophysiol. 2015;44:289-296.
    1. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42:3427-3520.
    1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42:3599-3726.
    1. Dewidar O, Dawit H, Barbeau V, Birnie D, Welch V, Wells GA. Sex differences in implantation and outcomes of cardiac resynchronization therapy in real-world settings: a systematic review of cohort Studies. CJC Open. 2022;4:75-84.

LinkOut - more resources