Author + information
- Received April 9, 2019
- Revision received May 30, 2019
- Accepted June 4, 2019
- Published online September 16, 2019.
- Angelo Auricchio, MD, PhDa,∗ (, )
- Maurizio Gasparini, MDb,
- Cecilia Linde, MDc,
- Dan Dobreanu, MDd,
- Óscar Cano, MDe,
- Maciej Sterlinski, MDf,
- Nigussie Bogale, MDg,
- Christoph Stellbrink, MDh,
- Marwan M. Refaat, MDi,
- Carina Blomström-Lundqvist, MDj,
- Christiane Lober, MSck,
- Kenneth Dickstein, MDg,l and
- Camilla Normand, MDg,l
- aDivision of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
- bDepartment of Cardiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- cHeart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
- dInstitute of Cardiovascular Disease and Transplant, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
- eElectrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- fHeart Rhythm Department, Institute of Cardiology, Warsaw, Poland
- gDepartment of Cardiology, Stavanger University Hospital, Stavanger, Norway
- hDepartment of Cardiology, Klinikum Bielefeld, Bielefeld, Germany
- iDivision of Cardiology, Department of Internal Medicine, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
- jDepartment of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
- kDepartment of Statistics, IHF GmbH, Ludwigshafen, Germany
- lInstitute of Internal Medicine, University of Bergen, Bergen, Norway
- ↵∗Address for correspondence:
Dr. Angelo Auricchio, Fondazione Cardiocentro Ticino, Via Tesserete 48, CHF-6900 Lugano, Switzerland.
Objectives This study sought to compare sex difference for procedural aspects and complications in the European Society of Cardiology CRT Survey II, exploring whether adverse events were related to the type of CRT device implanted.
Background Sex-related differences in procedural aspects and complications in patients undergoing cardiac resynchronization therapy (CRT) implantation has not been explored in a real-life population.
Methods A post-hoc analysis of procedural data and complications in different sexes and factors associated with events was performed from data collected in the European Society of Cardiology CRT Survey II.
Results Of all patients (n = 11,088) included, 24.3% were women. The mean age (70 years of age) of male and female recipients was similar. Female patients more frequently had an idiopathic cardiomyopathy (67.4% vs. 44.1%) and fewer comorbidities, including atrial fibrillation (34.8% vs. 42.8%), diabetes (29.1% vs. 32.1%), chronic obstructive lung disease (10.3% vs. 12.6%), and renal failure (28.7% vs. 31.9%), compared with men. More women compared with men had a pacemaker (56.6% vs. 46.3%) and much less often an implantable cardioverter-defibrillator (CRT-D) (19.0% vs. 34.7%) implant. Periprocedural event rate was the highest in women with CRT with defibrillator (7.1% vs. 4.8% in men), followed by women with a CRT with pacing (5.5% vs. 4.4% in men). The higher periprocedural event rate in CRT-D women was attributable primarily to the occurrence of pneumothorax (1.4%), coronary sinus dissection (2.1%), and pericardial tamponade (0.3%). The rate of in-hospital major adverse events (6.0%) and complications necessitating reoperation (4.0%) was not different among sex and device type.
Conclusions Women are more likely to experience adverse procedure-related events during CRT implantation. Thus, preventive strategies should be employed to minimize complication rate.
- cardiac devices
- cardiac resynchronization therapy
- European practice
- heart failure
The work was supported by the European Heart Rhythm Association, the Heart Failure Association, Biotronik, Boston Scientific, Medtronic, Sorin, St. Jude Medical, Abbott, Bayer, Bristol-Myers Squibb, and Servier. Dr. Auricchio has served as a consultant to Abbott, Biosense Webster, Daiichi-Sankyo, Boston Scientific, Medtronic, Microport-CRM; and has received speaker fees from Daiichi-Sankyo, Boston Scientific, Medtronic, and Microport-CRM. Dr. Linde has received research grants from AstraZeneca, the Stockholm County Council, and Heart-Lung-Foundation; and has received speaker honoraria from Abbott, Medtronic, Vifor, Novartis, Boston Scientific, LivaNova, and Impulse Dynamics. Dr. Dobreanu has served as a consultant to Biotronik; and has received speaker fees from Biotronik, Medtronic, Servier, Pfizer, Bayer, and Novartis. Dr. Cano has served as a consultant to Abbott and Biosense Webster. Dr. Sterlinski has received consulting and lecture honoraria from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr. Stellbrink has served as a sponsored investigator for Abbott, Biotronik, and Medtronic. Dr. Blomström-Lundqvist has received research grants from Medtronic, Cardiome; and has received personal fees from Bayer, Sanofi, Boston Scientific, and Merck Sharp and Dohme outside the submitted work. Dr. Normand has received research support from Biotronik, Boston Scientific, Medtronic, LivaNova, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 9, 2019.
- Revision received May 30, 2019.
- Accepted June 4, 2019.
- 2019 American College of Cardiology Foundation
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