Women and ICDs: More Complications and Fewer Benefits Reply

After consulting an electrophysiologist, women are just as likely as men to receive an ICD but they suffer more complications and are less likely to benefit from the device, according to a new study from Canada published in Annals of Internal Medicine.

Derek MacFadden and colleagues analyzed data from 6,021 patients treated at 18 ICD implantation centers in Canada. 21.4% of the patients were women. The rate of ICD implantation was similar in men and women, but women were more likely to have complications and less likely to receive appropriate shocks or antitachycardia pacing:

  • Major Complications by 45 Days: OR 1.78 (CI 1.24 – 2.58, p=0.002)
  • Major complications by 1 year: HR 1.91, (CI 1.48 – 2.47, p= 0.001)
  • Receive appropriate ICD shock: HR 0.69 (CI 0.51 – 0.93, p= 0.015)
  • Receive appropriate shock or antitachycardia pacing: HR 0.73 (CI 0.59 – 0.90, p=0.003)
The lower rate of appropriate ICD therapy for women “suggests that their baseline arrhythmic risk is lower under current primary and secondary prevention eligibility criteria,” write the authors.

In an accompanying editorial, Pamela Douglas and Lesley Curtis point out that there is “ample evidence” for sex-related differences in the epidemiology and biology of sudden death and  arrhythmias but the low enrollment of women in the major ICD trials “make it difficult to fully assess the value of ICDs in women.” They call for a “careful evaluation” of “the validity of applying a one-size-fits-all approach” to ICD usage.

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