Gender differences in ventricular arrhythmia recurrence in patients with coronary artery disease and implantable cardioverter-defibrillators

OBJECTIVES We sought to determine whether men and women with coronary artery disease (CAD) and implantable cardioverter-defibrillators (ICDs) diffier in frequency of arrhythmia recurrence and whether gender differences are independent of clinical, electrocardiographic, and electrophysiologic characteristics. BACKGROUND Epidemiologic studies show that women have a lower rate of sudden cardiac death (SCD) than men, even among patients with CAD. Whether this is due to diffiering susceptibilities to ischemia or to arrhythmia is unknown. METHODS The clinical records and ICD data disks of 340 men and 59 women with CAD who received an ICD between June 1990 and June 2000 were reviewed. Ventricular tachycardia (VT) or ventricular fibrillation (VF) recurrences were compared between genders and relationship with other factors was analyzed. RESULTS Sustained VT/VF occurred in 52% of men and 34% of women (p < 0.01). Men experienced more total VT/VF events (p < 0.01), more shock-treated VT/VF events (p < 0.03), more electrical storms (p < 0.001), and had VT/VF on more days in follow-up (p < 0.01). Gender differences were independent of measured clinical, electrocardiographic, and electrophysiologic factors. In stratified analyses, the gender diffierences in VT/VF recurrence were greatest in patients presenting with sustained monomorphic VT and those with inducible VT at electrophysiology study. CONCLUSIONS Women were less likely to experience VT/VF, and had fewer VT/VF episodes, than men. These findings were strongest in patients with evidence of a stable anatomic VT circuit: those with clinical or electrophysiologically induced VT. This study suggests that differing susceptibility to arrhythmia triggering may underlie the known diffierences in SCD rates between men and women. (C) 2004 by the American College of Cardiology Foundation.