Gender differences in patients with structural heart disease undergoing VT ablation

Abstract

Introduction: This study sought to examine gender differences in patients with structural heart disease (SHD) referred for ablation of ventricular tachycardia (VT). Background: Female patients are often underrepresented in large studies. Significant differences in the clinical presentation, treatment, and prognosis of female patients have been described in previous studies. Methods and Results: We investigated 88 female patients with SHD undergoing VT ablation (mean age 59 years, 56% nonischemic cardiomyopathy, mean left ventricular ejection fraction 35%, 82% in electrical storm). A case-control study with 88 male patients was performed and the results regarding clinical and procedural characteristics, acute and long-term results of the two groups were compared. The female patients had more arrhythmogenic substrate, as they more commonly presented with electrical storm (p =.016) and had a higher number of inducible VT morphologies during the procedure (p =.018). Moreover, the female patients were less likely to have an optimized heart failure medical treatment at baseline (p =.030) and required more time from the first manifestation of the VT to ablation referral (p =.034). Although fewer epicardial ablations were performed in female patients (p =.019), the two groups showed similar results regarding VT noninducibility as ablation endpoint (p =.844), major procedure-related complications (p =.719) and freedom from VT during follow-up (p =.268). Moreover, the overall mortality in the two groups was similar (p =.176). Advanced NYHA class was associated with worse transplant and assist-device-free survival in the female group. Conclusion: Female patients presenting for VT ablation had more arrhythmogenic substrate and were less likely to have an optimized heart failure medical treatment. Nevertheless, the procedural acute and long-term outcomes between the two genders were similar.