First, recurrent tachycardia is less likely in women than in men with primary prevention ICD


Disclosures: Saxena does not report any relevant financial information. Please see the study for relevant financial information from all other authors. Sticherling reports receiving personal fees from Abbott, Biotronik, Boston Scientific and Medtronic.


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Women with heart failure who received an implantable cardioverter defibrillator as primary prevention were less likely to experience life-threatening initial and recurrent ventricular tachycardias than men, the researchers reported.

“Previous studies of patients with ICDs have demonstrated conflicting results regarding the association of gender with the incidence of appropriate device treatment, overall mortality, and thus the benefit of prophylactic placement of ICDs in ICDs. women with HF”, Shireen Saxena, BAcandidate of medicine at the Center for Clinical Cardiovascular Research at the University of Rochester Medical Center, New York, and his colleagues wrote in Open JAMA Network. “We sought to assess the association between gender and the risk of first occurrence of sustained ventricular tachyarrhythmia, total ventricular tachyarrhythmia, and shock load during the follow-up period in an analysis of recurrent events, and nonarrhythmic mortality in all patients with primary prevention implantation CDI who were enrolled in the Multicenter Automated Defibrillator Implantation Trials (MADIT).


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MADIT trials

The MADIT trials evaluated the outcomes of patients with ischemic cardiomyopathy, left ventricular ejection fraction less than 35%, and ventricular tachycardia implanted with an ICD or cardiac resynchronization therapy defibrillator compared to no ‘implant.

Like Healio Previously reportedCRT in patients with IC and ventricular tachycardia was associated with lower rates of ventricular arrhythmia events, sudden cardiac death, and all-cause death over time compared to those without ICDs .

In the present analysis of the MADIT trials, researchers assessed gender differences in risk of mortality and ventricular tachycardia in 4506 patients (mean age, 64 years; 76% male). The primary endpoint was sustained ventricular tachycardia, defined as recorded, treated, or ICD-monitored ventricular tachycardia of at least 170 beats per minute or ventricular fibrillation. Secondary endpoints included ventricular tachycardia of at least 200 beats per minute, appropriate ICD shocks, and appropriate anti-tachycardia pacing.

Within this cohort, age and LVEF were similar between men and women; however, women had fewer non-ischemic cardiomyopathies (42% versus 74%).

Researchers found that women had a lower 3-year risk of sustained ventricular tachycardia (16% versus 26%), rapid ventricular tachycardia (9% versus 17%), and appropriate ICD shocks (7% versus 15%) compared to men (P for all < .001).

Women were about 40% lower risk for all outcomes (P for all < 0.001), including the primary endpoint (HR for first event = 0.6; 95% CI, 0.5-0.73; P <0.001; HR for recurrent event = 0.49; 95% CI, 0.43-0.55; P < 0.001), depending on the study.

Saxena and colleagues reported that these findings were consistent across subgroup analysis and were more pronounced in women with nonischemic cardiomyopathy compared to men (RR for nonischemic = 0.5; 95% CI , 0.38-0.66; P <0.001; HR for ischemic = 0.73; 95% CI, 0.56-0.95; P = 0.02; P for the interaction between female gender and cardiomyopathy = 0.03).

“To our knowledge, this is the first study to examine gender differences not only in the initial onset of ventricular tachyarrhythmia or first appropriate ICD treatment, but also in the overall burden of each of these parameters. in patients receiving ICD implantation for primary prevention,” the researchers wrote. “Specifically, our results showed that women have about half the risk of recurrent ventricular tachyarrhythmia, or recurrent appropriate ICD shocks, compared to men, which was again more pronounced in nonischemic cardiomyopathy than in cardiomyopathy. ischemic.”

Importance of gender risk stratification

In a related editorial, Christian Sticherling, MDDeputy Chief Physician and Head of Department of Electrophysiology, Department of Cardiology, University Hospital Basel, University of Basel, Switzerland, explained how these results highlight the importance of gender-based risk stratification.

“How can the presented results be useful in day-to-day decision-making? It is unlikely that the specificity and negative predictive value of a single risk parameter… will suffice to replace left ventricular ejection fraction as a risk marker in primary prevention. Composite risk scores such as the MADIT-ICD benefit score or the DERIVATE score are more likely to be beneficial,” Sticherling wrote. “Saxena et al’s work underscores once again that there are important differences in cardiovascular outcomes between men and women and that the under-representation of women in randomized controlled trials is an issue that needs to be addressed. account.”

Reference:

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