Gender Differences In The Treatment Of Cardiovascular Implantable Electronic Devices

Part ?Gender Differences in Pacemaker ImplantationBackground Gender differences are increasingly recognized in cardiology,including cardiovascular implantable electronic devices.However,currently,relevant studies are mostly based on foreign population but little on Chinese.Moreover,there is also a lack of research focusing on gender differences in cardiac pacing therapy.Objectives This study aimed to explore the gender differences of cardiac pacing therapy in Chinese.Methods This is a retrospective study.Data was collected from the National Arrhythmic Intervention Therapy Registry.Patients with pacemaker implantation from January 2015 to December 2016 were included.Patient demographics,underlying cardiovascular diseases,cardiac function,clinical indications and device types were collected and compared between sexes.In addition,the whole population was further divided into three groups according to age,young and middle-aged group(<60 years old),elderly group(?60 years old and<80 years old)and advanced-aged group(? 80 years old)for evaluating the gender differences of different age groups.Results A total of 7203 patients were included,with an average age of 67.9±13.2 years old.Men account for 48.7%of pacemaker implantation,lower than that of women(51.3%),but the proportion of men was higher than women in the advanced-aged group(55.9%vs.44.1%).The average age of men was 68.3±13.6 years old,significantly higher than that of female(P=0.021).Male patients had more atrioventricular block(40.3%vs.30.1%,P<0.001)and chronic atrial fibrillation with long RR intermittent or slow ventricular rate(13.5%vs.9.1%,P<0.001)and less sick sinus syndrome(51.0%vs.63.9%,P<0.001)when compared with women.Women received significantly more dual-chamber devices than men in the whole population(81.1%vs 85.3%,P<0.001),but the difference is not shown in advanced-aged group(76.1%vs 77.2%,P=0.716).In addition,we found no significant differences on device type selection between sexes of subgroups which was divided according to pacing indication.Conclusion Gender differences has certain influence on pacemaker implantation in Chinese.In patients younger than 80 years old,men were less likely to receive implants,while the situation is opposite in patients being 80 years and older.Men were older than women at the time of implantation and had significantly more atrioventricular block and chronic atrial fibrillation with long RR intermittent or slow ventricular and less percentage of sick sinus syndrome compared with women.Gender difference has l ittle influence on the choice of pacemaker type.Part ?Gender differences in Implantable cardioverter defibrillatorBackground and Aims Implantable cardioverter defibrillator(ICD)is useful for the prevention of SCD.However,there are gender differences regarding the utilization of ICD.We aim to appraise the gender differences in ICD utilization in China.Methods A prospective registration analysis was performed in patients with implanted ICD from May 2013 to November 2015 in twenty hospitals via arrhythmic interventional therapy registry system.Results A total of 664 patients who implanted ICD were enrolled in the baseline cohort.484(72.9%)patients were male,which were more than female patients(n=180,27.1%).Male was more likely received an ICD due to ischemia cardiomyopathy and dialated cardiomyopathy,(35.5%vs.14.4%,P<0.001)and(21.0%vs.13.3%,P=0.024),respectively.Female patients receiving an ICD were more likely due to cardiac ion channel disease(14.4%vs.3.1%,P<0.001).Female patients had better heart function,including smaller left ventricular end diastolic dimension and better left ventricular ejection fraction.There was higher percentage of male patients implanted ICD due to Class I indication than that of female patients(66.9%vs.52.8%,P<0.001).Conclusions In real-world setting,there were more male patients than female patients who received ICD implantation.Compared with male,female patients have different epidemiology,pathophysiology and heart function,and all these factors may affect the utilization of ICD implantation.But it also possibility that the female receive less consulting may play a role in this apparent discrimination.Part ?Gender differences in cardiac resynchronization therapyBackground Heart failure has certain gender differences in epidemiology,pathophysiology,clinical presentation and prognosis.At present,there have been relevant research reports on the influence of gender on the clinical application of cardiac resynchronization therapy(CRT).However,there are few studies on the gender differences of CRT in China.Objectives The present study aimed to appraise the gender differences of CRT utilization in Chinese patients.Methods This was a retrospective,multicenter and open registry study.Data were from the database platform for interventional therapy of arrhythmia.All patients were enrolled if they received CRT device with or without ICD between January 2015 and December 2016.We collected patients' baseline clinical data,including demographic data,etiology,medical history,electrocardiogram(ECG),echocardiography data,clinical indications and device types.In addition,the whole population was further divided into three groups according to age,young and middle-aged group(<60 years old),elderly group(?60 years old and<70 years old)and advanced-aged group(? 70 years old)for evaluating the sex differences of different age groups.Results A total of 703 patients were included.The mean age was 61.9±10.7 year-old.Men accounted for 65.6%of CRT implantation,higher than women(34.4%).The mean age of women at the time of CRT implantation was older than men(P=0.014).Non-ischemic cardiomyopathy was the most common etiology in the patients who underwent the treatment of CRT,no matter male or female.More male patients received CRT-D therapy than female(56.5%vs.41.9%,P=0.001).Multivariable logistic regression analysis showed that males were independent influencing factors to increase the selection of CRT-D.Conclusion Gender differences have a certain impact on the utilization of CRT in Chinese patients.In clinical practice,the only 34.4%patients implanted CRT were female.Meanwhile,the percentage of CRT-D was much less in female than in male.Males are independent influencing factors for increasing the choice of CRT-D.Part ?The effect of gender on the prognosis of patients with implantable cardioverter defibrillatorBackground There are gender differences in clinical application of ICD in previous large-scale clinical trials and whether it is the same in the real world is unknown.Whether sex differences affect ventricular arrhythmia events and survival benefits in patients with ICD implants is unclear.Objective The aim of this study is to assess gender differences in the clinical use and benefits of ICD in the real world and to determine the effect of gender on the prognosis of ICD patients.Methods This study enrolled patients implanted with ICD with Home-Monitor system from May 2010 to May 2015.All the data came from home monitoring database including,general condition,underlying disease status,cardiac function status,the result of ECG and UCG,medication and device type,ventricular arrhythmia events and treatments.The end events were electroshock therapy and death.The independence risk factors of death were assessed according different gender.All patients were followed up until May 2018Results a total of 1015 patients were enrolled in this study.The mean follow-up period was 4.7±1.8 years,and the average age of the patients was 60.7±14.2 years.Among them,738(72.7%)were male patients and 497(49%)were NYHA ?-?.The incidence of coronary heart disease in male patients was significantly higher than that in female patients,and the ejection fraction was lower than that in female patients.Female patients were less likely to choose dual-chamber ICD and CRT-D.Ventricular arrhythmia events and electroshock therapy were significantly higher in male patients than in female patients.The difference of mortality between male and female mortality was not statistically significant.In terms of death risk factors,atrial fibrillation and NYHA ?-? are independent risk factors for death in male patients,while coronary heart disease and NYHA ?-? are independent risk factors for death in female patients.Conclusions in the real world,less than one-third of ICD patients are female.Among female patients,the proportion of ischemic cardiomyopathy is low,and the proportion of non-ischemic cardiomyopathy and long QT syndrome is high.There was no gender difference in ICD benefits...