Sex Differences in Outcomes of Tetralogy of Fallot Patients With Implantable Cardioverter-Defibrillators

Women with congenital heart disease at high risk for sudden cardiac death have been poorly studied thus far. The aim of this study was to assess sex-related differences in patients with tetralogy of Fallot (TOF) and implantable cardioverter-defibrillators (ICDs). Data were analyzed from the DAI-T4F...

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Published in:	JACC. Clinical electrophysiology Vol. 8; no. 10; pp. 1304 - 1314
Main Authors:	Labombarda, Fabien, Mondoly, Pierre, Al Arnaout, Alain, Anselme, Frédéric, Audinet, Caroline, Clerici, Gaël, Da Costa, Antoine, de Guillebon, Maxime, Defaye, Pascal, Elbaz, Nathalie, Garcia, Rodrigue, Guenancia, Charles, Guy-Moyat, Benoit, Halimi, Franck, Irles, Didier, Ladouceur, Magalie, Lagrange, Philippe, Mansourati, Jacques, Massoulié, Grégoire, Mathiron, Amel, Narayanan, Kumar, Nguyen, Cédric, Perier, Marie-Cécile, Sacher, Frédéric, Sharifzadehgan, Ardalan, Winum, Pierre, Zakine, Cyril, Pasquié, Jean-Luc, Marijon, Eloi, Albenque, Jean-Paul, Algalarrondo, Vincent, Badenco, Nicolas, Bader, Hugues, Baudinaud, Pierre, Blangy, Hughes, Bonnet, Damien, Bordchar, Pierre, Bouzeman, Abdeslam, Boveda, Serge, Cardin, Christèle, Chalbia, Tej, Chastre, Thomas, Chevallier, Philippe, Combes, Nicolas, De Guillebon, Maxime, Degand, Bruno, Derval, Nicolas, Di Filippo, Sylvie, Domain, Guillaume, Duparc, Alexandre, Duplantier, D Cécile, Duthoit, Guillaume, El Bouazzaoui, Rim, Enache, Bogdan, Fauchier, Laurent, Freysz, Luc, Gardey, Kevin, Geoffroy, Olivier, Gourraud, Jean-Baptiste, Guichard, Jean-Baptiste, Hascoet, Sébastien, Hermida, Alexis, Hermida, Jean-Sylvain, Hidden-Lucet, Françoise, Iserin, Laurence, Jauvert, Gaël, Jean, Frédéric, Jourda, François, Khoueiry, Ziad, Koutbi, Rita, Laborie, Guillaume, Lallemand, Pierre-Marc, Laredo, Mikael, Le Gloan, Laurianne, Leclercq, Christophe, Lellouche, Nicolas, Mabo, Philippe, Mandel, Franck, Martins, Raphaël, Messali, Anne, Mourot, Stéphane, Ollitrault, Pierre, Pasquie, Jean-Luc, Pavin, Dominique, Probst, Vincent, Puie, Paul, Romeyer-Bouchard, Cécile, Sadoul, Nicolas, Squara, Fabien, Waintraub, Xavier, Waldmann, Victor, Walton, Camille
Format:	Journal Article
Language:	English
Published:	Elsevier Inc 01-10-2022 Elsevier
Subjects:	Adult Cardiology and cardiovascular system Cohort Studies congenital heart disease Death, Sudden, Cardiac / epidemiology Death, Sudden, Cardiac / etiology Death, Sudden, Cardiac / prevention & control Defibrillators, Implantable / adverse effects Female Heart Defects, Congenital / complications Human health and pathology Humans implantable cardioverter-defibrillator Life Sciences Male Middle Aged Santé publique et épidémiologie sex Sex Characteristics sudden death tetralogy of Fallot Tetralogy of Fallot / complications ventricular arrhythmia women ventricular arrhythmia MRI sex LVEF TOF ICD tetralogy of Fallot PVS VF sudden death SCD RBBB congenital heart disease TCL implantable cardioverter-defibrillator VT women Tetralogy of Fallot Women Sudden death Sex Ventricular arrhythmia Congenital heart disease Implantable cardioverter-defibrillator
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Summary:	Women with congenital heart disease at high risk for sudden cardiac death have been poorly studied thus far. The aim of this study was to assess sex-related differences in patients with tetralogy of Fallot (TOF) and implantable cardioverter-defibrillators (ICDs). Data were analyzed from the DAI-T4F (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator) cohort study, which has prospectively enrolled all patients with TOF with ICDs in France since 2010. Clinical events were centrally adjudicated by a blinded committee. A total of 165 patients (mean age 42.2 ± 13.3 years) were enrolled from 40 centers, including 49 women (29.7%). Among the 9,692 patients with TOF recorded in the national database, the proportion of women with ICDs was estimated to be 1.1% (95% CI: 0.8%-1.5%) vs 2.2% (95% CI: 1.8%-2.6%) in men (P < 0.001). The clinical profiles of patients at implantation, including the number of risk factors for ventricular arrhythmias, were similar between women and men. During a median follow-up period of 6.8 years (IQR: 2.5-11.4 years), 78 patients (47.3%) received at least 1 appropriate ICD therapy, without significant difference in annual incidences between women (12.1%) and men (9.9%) (HR: 1.22; 95% CI: 0.76-1.97; P = 0.40). The risk for overall ICD-related complications was similar in women and men (HR: 1.33; 95% CI: 0.81-2.19; P = 0.30), with 24 women (49.0%) experiencing at least 1 complication. Our findings suggest that women with TOF at high risk for sudden cardiac death have similar benefit/risk balance from ICD therapy compared with men. Whether ICD therapy is equally offered to at-risk women vs men warrants further evaluation in TOF as well as in other congenital heart disease populations. (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator [DAI-T4F]; NCT03837574) [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2405-500X 2405-5018
DOI:	10.1016/j.jacep.2022.06.024