Gender Differences In Bradyarrhythmia In Patients With Pacemaker Implantation

ObjectiveThe aim of this study was to analyze whether there are gender differences in bradyarrhythmia,age of implantation,pacing parameters,and perioperative complications in patients with pacemaker implantation.MethodsA series of consecutive patients who had been implanted pacemaker due to bradycardia from January 2015 to December 2017 at Fuwai Hospital arrhythmic department Ward 1 were retrospectively enrolled.We collected the demography data including age and sex,the type of bradycardia,the type of pacemaker,pacing parameters,perioperative complications and other clinical data.The types of bradyarrhythmia were defined as sick sinus syndrome,two degree and complete atrioventricular block,persistent atrial fibrillation with long interval,binodal(sinoatrial node and atrioventricular node)disease.Pacemaker parameters included the atrial and ventricular sensing,pacing thresholds,and lead impedances measured during implantation procedure.There were dual-chamber and single-chamber pacemakers.Perioperative complications were defined as electrode dislocation,electrode perforation,pneumothorax,and pacemaker infection.According to whether patients are less than 60 years old,all patients were divided into young and middle-aged patients(<60 years old)and elderly patients(≥60 years old).We then analyzed whether there are gender differences in the type of bradycardia,pacing parameters,perioperative complications and so on in pacemaker implantation.ResultsA total of 1431 adult patients who were dignosed bradyarrhythmia were finally enrolled.The average age of general patients is 68.1±13.1 and the proportion of male is 47.5%(680 cases).Among all patients,51.1%of patients were diagnosed with sick sinus syndrome,19.5%with third-degree atrioventricular block,11.9%with persistent atrial fibrillation with long interval,8.2%with second-degree atrioventricular block,and 9.3%with binodal disease.Sex-specific analysis found that the type of bradyarrhythmia were significantly different between male and female patients(P<0.001).In female patients,the prevalence of sick sinus syndrome were significantly higher than that in male patients(60.1%vs 41.2%,P<0.001),while the prevalence of atrioventricular block(23.3%vs 32.5%,P<0.001)and persistent atrial fibrillation with long interval(9.6%vs 14.6%,P<0.01)were significantly lower than that in male patients.This gender differences were also found in the young and middle-aged patients as well as in the elderly patients.In the young and middle-aged patients,the age of implantation of male patients with sick sinus syndrome was significantly younger than that of female patients(49.7±10.3 vs 53.0±7.1,P<0.05).In the elderly patients,the age of implantation of male patients was older than that offemale patients with Ⅱ° degree atrioventricular block(75.5±7.7 vs 72.8±6.2,P<0.05)as well as female patients with atrial fibrillation with long interval(74.5±8.4 vs 70.8±6.9,P<0.01).The type of pacemaker was not different between male and female in young and middle aged group.In elderly population,female patients were more common to receive DDD pacemaker(89.5%vs 79.5%,P<0.001).Most pacing parameters did not differ between male and female patients except for the higher R wave of ventricular lead sensing(11.1±5.2mv vs 10.0±4.6mv,P=0.04)in male in the young and middle-aged patients,as well as the higher P wave of atrial lead sensing(3.7 ± 5.1mv vs 2.9 ±1.5mv,P=0.001)and the higher R wave of ventricular lead sensing(11.3 ±5.0mv vs 10.7±4.7mv,P=0.02)in male in the elderly population.The incidence of pneumothorax is 0.3%.The incidence of electrode dislocation is 1.1%.The incidence of electrode perforation is 0.2%.The incidence of pacemaker infection is 0.4%.Gender differences were not found in the perioperative complications in all patients.ConclusionsThe types of bradyarrhythmia were different between female and male patients with pacemakers.The prevalence of sick sinus syndrome was higher in female than that in male,while the prevalence of atrioventricular block and persistent atrial fibrillation with long interval were higher in men than that in women.The gender difference in bradyarrhythmia existed in both middle-aged and elderly population.In the middle-aged population,the age of implantation of female patients with sinus node syndrome was older,while in the elderly population,the age of implantation of male patients with second-degree AV block or persistent atrial fibrillation with long interval was older.Pacing parameters were different in lead sensing between male and female patients.Elderly female patients were more common to receive dual-chamber pacemaker than male.Gender difference was not found in perioperative complications.