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CLINICAL RESEARCH: ELECTROPHYSIOLOGY

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

Rachel Lampert, MD, FACC^*,*, Craig A. McPherson, MD, FACC^*, Jude F. Clancy, MD^*, Teresa L. Caulin-Glaser, MD, FACC, Lynda E. Rosenfeld, MD, FACC^* and William P. Batsford, MD^*

^* Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut, USA
McConnell Heart Health Center, Riverside Methodist Hospital, Columbus, Ohio, USA

Manuscript received January 14, 2004; revised manuscript received February 27, 2004, accepted March 2, 2004.

^* Reprint requests and correspondence: Dr. Rachel Lampert, Yale University School of Medicine, Section of Cardiology, 333 Cedar Street, FMP 3, New Haven, Connecticut 06520, USA.
rachel.lampert{at}yale.edu

OBJECTIVES: We sought to determine whether men and women with coronary artery disease (CAD) and implantable cardioverter-defibrillators (ICDs) differ 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 differing 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 differences 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 differences in SCD rates between men and women.

Abbreviations and Acronyms   AVID = Anti-arrhythmics Versus Implantable Defibrillators trial   CAD = coronary artery disease   ECG = electrocardiogram   EF = ejection fraction   EPS = electrophysiologic study   ICD = implantable cardioverter-defibrillator   MADIT = Multicenter Automatic Defibrillator Implantation Trial   MUSTT = Multicenter UnSustained Tachycardia Trial   SCD = sudden cardiac death   VF = ventricular fibrillation   VT = ventricular tachycardia

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