Sex Differences in Inappropriate ICD Device Therapies: MADIT‐II and MADIT‐CRT. (27th October 2016)

• Record Type: Journal Article
• Authors: TOMPKINS, CHRISTINE M.; MCNITT, SCOTT; POLONSKY, BRONISLAVA; DAUBERT, JAMES P.; WANG, PAUL J.; MOSS, ARTHUR J.; ZAREBA, WOJCIECH; KUTYIFA, VALENTINA
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 28:Number 1(2017)
• Page Start: 94
• Page End: 102
• Publication Date: 2016-10-27
• Subjects: antitachycardia -- cardiac resynchronization therapy -- heart failure -- ICD shock -- inappropriate therapy -- pacing -- sex differences; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.13102
• Languages: English
• ISSNs: 1045-3873

Abstract

Sex Differences in Inappropriate ICD Device Therapies: Introduction: Approximately 10–20% of ICD recipients receive inappropriate device therapies. The purpose of this study was to compare the frequency of inappropriate therapies (IT) between men and women enrolled in MADIT II and MADIT‐CRT, and assess for potential adverse outcomes. Methods: The electrograms for each ICD or CRT‐D therapy, defined as either ATP or shock, were reviewed by adjudication committees for both studies. ICD therapy was considered inappropriate if it was delivered for reasons other than VT/VF. The rhythm triggering IT was categorized as atrial fibrillation/flutter, SVT, or inappropriate sensing when possible. Results: One thousand nine hundred and fifty‐four men and 556 women received ICD or CRT‐D devices. The risk of IT was significantly lower in women than men (9.2% vs. 13.5%, P = 0.006). The most common cause of IT in men was atrial fibrillation (38%) and SVT in women (43%). Inappropriate shock was not associated with increased mortality in either women (HR 0.82 [95% CI 0.11–6.08]; P = NS) or men (HR 1.37 [95% CI 0.75–2.48]; P = NS) by multivariate analysis. Conversely, appropriate shock therapy strongly correlated with increased risk of death during subsequent post‐shock follow‐up in women (HR 5.99 [95% CI 2.75–13.02]; P < 0.0001) and men (HR 2.61 [95% CI 1.82–3.74]; P < 0.0001). Conclusions: Women experience significantly less IT than men, partially explained by the increased frequency of atrial fibrillation in men. IT was not associated with increased mortality in either sex. Appropriate shock therapy was a strong predictor of death in both, with women showing a 2‐fold higher risk than men during post‐shock long‐term follow‐up.