Do gender differences exist in pacemaker implantation?--results of an obligatory external quality control program

Nowak, Bernd; Misselwitz, Björn; Erdoğan, Ali; Funck, R.; Irnich, Werner; Israel, Carsten W.; Olbrich, H. G.; Schmidt, Henner; Sperzel, Johannes; Zegelman, M.

doi:10.1093/europace/eup312

Cited by 108 publications

(92 citation statements)

References 26 publications

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“…In general, women are more likely to have SSS, atrioventricular nodal reentrant tachycardia, and long QT syndrome. On the other hand, men are more likely to have atrioventricular block, atrioventricular reentrant tachycardia, idiopathic ventricular fibrillation, and BS 15, 16. A family history of SD or a Brugada‐type ECG is important for the management of BS.…”

Section: Discussionmentioning

confidence: 99%

Sex‐Dependent Phenotypic Variability of an SCN5A Mutation: Brugada Syndrome and Sick Sinus Syndrome

Aizawa

Fujisawa

Katsumata

et al. 2018

JAHA

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BackgroundBrugada syndrome (BS) is known to be 9 times more prevalent in males than females. However, little is known about the development of sick sinus syndrome in female members with familial BS.Methods and ResultsFamilial BS patients and family members, both from our institutions and collaborating sites that specialize in clinical care of BS, participated in this study. We collected information on their clinical and genetic background, along with the inheritance patterns of BS. Detailed information on each case with familial BS is described. A total of 7 families, including 25 BS patients (12 females and 13 males), were included. Seven were probands and 18 were family members. Ten out of the 12 female patients and none of the 13 male patients developed sick sinus syndrome. Sudden death or spontaneous ventricular fibrillation occurred in 7 out of 13 male patients and 2 out of 12 female patients.ConclusionsFamilial BS existed in which female patients developed sick sinus syndrome but male patients did not. Some of those female patients with sick sinus syndrome had unrecognized BS. Information should be collected not only regarding a family history of sudden death or BS, but also whether a pacemaker was implanted in female members.

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Section: Discussionmentioning

confidence: 99%

Sex‐Dependent Phenotypic Variability of an SCN5A Mutation: Brugada Syndrome and Sick Sinus Syndrome

Aizawa

Fujisawa

Katsumata

et al. 2018

JAHA

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“…12 Additionally, research suggests that there may be differences between the sexes at pacemaker implantation, with less favourable outcomes for women in terms of complications. 13 Patients with SSS are at risk of developing a complete AV block, with considerable variation in the estimates of risk of AV block (from < 1% up to 4.5% per year). 4,14 A patient with SSS who develops AV block will require ventricular pacing (VP) and, consequently, an upgrade to a dual-chamber pacemaker if they already have a single-chamber atrial pacemaker.…”

Section: Description Of Health Problemmentioning

confidence: 99%

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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BackgroundBradycardia [resting heart rate below 60 beats per minute (b.p.m.)] can be caused by conditions affecting the natural pacemakers of the heart, such as sick sinus syndrome (SSS) and atrioventricular (AV) blocks. People suffering from bradycardia may present with palpitations, exercise intolerance and fainting. The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker.ObjectiveTo appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block.Data sourcesAll databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) were searched from inception to June 2014.MethodsA systematic review of the clinical and economic literature was carried out in accordance with the general principles published by the Centre for Reviews and Dissemination. Randomised controlled trials (RCTs) evaluating dual-chamber and single-chamber atrial pacemakers and economic evaluations were included. Pairwise meta-analysis was carried out. A de novo economic model was developed.ResultsOf 493 references, six RCTs were included in the review. The results were predominantly influenced by the largest trial DANPACE. Dual-chamber pacing was associated with a statistically significant reduction in reoperation [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.36 to 0.63] compared with single-chamber atrial pacing. The difference is primarily because of the development of AV block requiring upgrade to a dual-chamber device. The risk of paroxysmal atrial fibrillation was also reduced with dual-chamber pacing compared with single-chamber atrial pacing (OR 0.75, 95% CI 0.59 to 0.96). No statistically significant difference was found between the pacing modes for mortality, heart failure, stroke, chronic atrial fibrillation or quality of life. However, the risk of developing heart failure may vary with age and device. The de novo economic model shows that dual-chamber pacemakers are more expensive and more effective than single-chamber atrial devices, resulting in a base-case incremental cost-effectiveness ratio (ICER) of £6506. The ICER remains below £20,000 in probabilistic sensitivity analysis, structural sensitivity analysis and most scenario analyses and one-way sensitivity analyses. The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers. Results from an analysis based on age (> 75 years or ≤ 75 years) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers (i.e. are less expensive and more effective) in older patients, whereas dual-chamber pacemakers are dominated by (i.e. more expensive and less effective) single-chamber atrial pacemakers in younger patients. However, these results are based on a subgroup analysis and should be treated with caution.ConclusionsIn patients with SSS without evidence of impaired AV conduction, dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers. The risk of developing a complete AV block and the lack of tools to identify patients at high risk of developing the condition argue for the implantation of a dual-chamber pacemaker programmed to minimise unnecessary ventricular pacing. However, considerations have to be made around the risk of developing heart failure, which may depend on age and device.Study registrationThis study is registered as PROSPERO CRD42013006708.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…In an analysis on 36,312 elderly Medicare beneficiaries undergoing pacemaker implantation, Lamas et al showed that male gender was an independent predictor of a dual-chamber pacemaker implantation, 33 thus supporting a sex-bias in pacemaker implantation procedures. 34,35 With regard to complications, females experience more adverse events from pacemaker implantation. 35 Nowak et al recently reported that women had increased rates of procedure-related complications than men, with higher incidence of pneumothorax (odds ratio (OR) 2.12, 95 % confidence interval (CI) 1.39-3.24), especially when analysing the subclavian vein access group (OR 4.02, 95 % CI 1.91-8.45), and a higher incidence of pocket haematoma (OR 1.49, 95 % CI 1.05-2.11).…”

Section: Permanent Pacemakersmentioning

confidence: 99%

“…35 Nowak et al recently reported that women had increased rates of procedure-related complications than men, with higher incidence of pneumothorax (odds ratio (OR) 2.12, 95 % confidence interval (CI) 1.39-3.24), especially when analysing the subclavian vein access group (OR 4.02, 95 % CI 1.91-8.45), and a higher incidence of pocket haematoma (OR 1.49, 95 % CI 1.05-2.11). 35 In addition to women's older age and co-morbidities, smaller body size of females and a more challenging implantation procedure due to thinner right ventricular wall, smaller blood vessel diameter and a higher prevalence of anatomical variations in venoarterial relationships may explain such findings. 21,[35][36][37][38] On the other side, female gender seems associated with a better outcome after pacemaker placement, with males experiencing poorer survival following pacemaker implantation.…”

Section: Permanent Pacemakersmentioning

confidence: 99%

“…35 In addition to women's older age and co-morbidities, smaller body size of females and a more challenging implantation procedure due to thinner right ventricular wall, smaller blood vessel diameter and a higher prevalence of anatomical variations in venoarterial relationships may explain such findings. 21,[35][36][37][38] On the other side, female gender seems associated with a better outcome after pacemaker placement, with males experiencing poorer survival following pacemaker implantation. 30,39 In conclusion, despite presenting to pacemaker implantation older, more symptomatic, with more co-morbidities, and experiencing more procedure-related complications, females seem to obtain a greater benefit from pacemaker implantation than males, with a lower long-term mortality.…”

Section: Permanent Pacemakersmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes in Women Undergoing Electrophysiological Procedures

Biase

Basile

Al‐Ahmad

2013

Arrhythmia &Amp; Electrophysiology Review

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The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

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Do gender differences exist in pacemaker implantation?--results of an obligatory external quality control program

Abstract: This large-scale real-life patient cohort of primary stationary pacemaker implantation showed that gender has an impact onto pacemaker implantation, with less favourable outcomes for women.

Cited by 108 publications

References 26 publications

Sex‐Dependent Phenotypic Variability of an SCN5A Mutation: Brugada Syndrome and Sick Sinus Syndrome

Sex‐Dependent Phenotypic Variability of an SCN5A Mutation: Brugada Syndrome and Sick Sinus Syndrome

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Outcomes in Women Undergoing Electrophysiological Procedures

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