Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women-Data From a Multicenter French Registry

Rui Providência , Eloi Marijon (1) , Pier D. Lambiase , Abdeslam Bouzeman , Pascal Defaye (2) , Didier Klug (3) , Denis Amet , Marie-Cécile Perier (4) , Daniel Gras (5) , Vincent Algalarrondo (6) , Jean-Claude Deharo (7) , Christophe Leclercq (8, 9) , Laurent Fauchier (10) , Dominique Babuty (10) , Pierre Bordachar (11) , Nicolas Sadoul (12) , Olivier Piot (13) , Serge Boveda (14)

1 HEGP - Hôpital Européen Georges Pompidou [APHP]
2 Cardiac Stimulation and Rhythmology
3 Hôpital cardiologique
4 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
5 Nouvelles Cliniques Nantaises
6 Hôpital Antoine Béclère
7 Service de cardiologie
8 LTSI - Laboratoire Traitement du Signal et de l'Image
9 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]
10 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
11 Hôpital Haut-Lévêque
12 Service de Cardiologie [CHRU Nancy]
13 CCN - Centre cardiologique du Nord
14 Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC

BACKGROUND: There are limited data describing sex specificities regarding implantable cardioverter defibrillators (ICDs) in the real-world European setting. METHODS AND RESULTS: Using a large multicenter cohort of consecutive patients referred for ICD implantation for primary prevention (2002-2012), in ischemic and nonischemic cardiomyopathy, we examined the sex differences in subjects' characteristics and outcomes. Of 5539 patients, only 837 (15.1%) were women and 53.8% received cardiac resynchronization therapy. Compared to men, women presented a significantly higher proportion of nonischemic cardiomyopathy (60.2% versus 36.2%, P\textless0.001), wider QRS complex width (QRS \textgreater120 ms: 74.6% versus 68.5%, P=0.003), higher New York Heart Association functional class (≥III in 54.2%♀ versus 47.8%♂, P=0.014), and lower prevalence of atrial fibrillation (18.7% versus 24.9%, P\textless0.001). During a 16 786 patient-years follow-up, overall, fewer appropriate therapies were observed in women (hazard ratio=0.59, 95% CI 0.45-0.76; P\textless0.001). By contrast, no sex-specific interaction was observed for inappropriate shocks (odds ratio ♀=0.84, 95% CI 0.50-1.39, P=0.492), early complications (odds ratio=1.00, 95% CI 0.75-1.32, P=0.992), and all-cause mortality (hazard ratio=0.87 95% CI 0.66-1.15, P=0.324). Analysis of sex-by- cardiac resynchronization therapy interaction shows than female cardiac resynchronization therapy recipients experienced fewer appropriate therapies than men (hazard ratio=0.62, 95% CI 0.50-0.77; P\textless0.001) and lower mortality (hazard ratio=0.68, 95% CI 0.47-0.97; P=0.034). CONCLUSIONS: In our real-life registry, women account for the minority of ICD recipients and presented with a different clinical profile. Whereas female cardiac resynchronization therapy recipients had a lower incidence of appropriate ICD therapies and all-cause death than their male counterparts, the observed rates of inappropriate shocks and early complications in all ICD recipients were comparable. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01992458

Mots clés: death; sudden; heart failure; mortality; shock

Domaines: Sciences du Vivant [q-bio]

Rui Providência, Eloi Marijon, Pier D. Lambiase, Abdeslam Bouzeman, Pascal Defaye, et al.. Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women-Data From a Multicenter French Registry. Journal of the American Heart Association, 2016, 5 (2), ⟨10.1161/JAHA.115.002756⟩. ⟨hal-01290417⟩