Gender Differences in Implantable Cardioverter-Defibrillator Utilization for Primary Prevention of Sudden Cardiac Death

Purpose of review: Implantable cardioverter-defibrillator (ICD) implantation is a guideline-recommended indication for primary prevention of sudden cardiac death (SCD) in high-risk patients. ICD implantation is lower in women than in men, a difference that has persisted over the last two decades. The goal of this review is to explore potential factors in under- utilization of ICDs in women and to provide information on gender differences in mortality benefit of ICDs. Recent findings: Epidemiological evidence shows that women with cardiovascular disease tend to present at an older age, have more non-ischemic cardiomyopathy, and develop fewer ventricular arrhythmias than men. Significant gender differences in participants of ICD clinical trials challenge the applicability of mortality benefit of ICDs in women. Studies of cardiac resynchronization therapy (CRT) devices have shown improved survival in women over men, a fact that is not reflected in the number of CRTs implanted in women. Summary: A gender gap in the implantation of ICDs for primary prevention of SCD continues to exist. Understanding of differences in epidemiology and physiology between women and men is an important step in providing appropriate device therapy to patients at risk of SCD.