Gender Differences in Ventricular Tachyarrhythmia Events in the Raid Trial
Kutyifa V, Vloka ME, Huang DT, Varanasi SN, Shinn TS, Attari M, Shah AH, Lessmeier TJ, Musat DL, Rosenthal LS, Sakaguchi S, Sun AY, McNitt S, Schleede S, Schuger CD, Natale A, McPherson CA, Ziv O, Daubert JP, and Zareba W. Gender Differences in Ventricular Tachyarrhythmia Events in the Raid Trial. Heart Rhythm 2019; 16(5):351.
Background: Women have previously shown to be at a lower risk of ventricular tachyarrhythmia (VT) events in ICD trials, however, more contemporary data on the risk of VT/VF by gender, utilizing uniform, novel ICD programming are lacking. Objective: We aimed to assess gender differences in VT/VF events treated with ATP or treated with shock, and all-cause mortality in the RAID trial. Methods: The RAID trial enrolled high-risk ICD patients with ischemic or non-ischemic cardiomyopathy randomized to ranolazine or placebo. ICD programming was pre-specified with VT zone 190-220 bpm with 1 ATP and shocks and VF zone >220 bpm with shocks. Gender differences in VT/VF requiring ATP or shock were evaluated using Kaplan-Meier analysis and Cox models in an intention to treat analysis. All VT/VF episodes were centrally adjudicated. Results: There were 186 women (18%) out of 1012 subjects enrolled in RAID trial. Women were younger (61 vs. 65 years, p<0.001), more often non-ischemic (71% vs. 40%), p<0.001), they less often had diabetes (25% vs. 35%, p=0.007), and they had a shorter QRS duration (121 vs. 133 ms (p<0.001). Compared to men, women were at a significantly lower risk of VT/VF/Death (HR=0.70, p=0.046), a lower risk of VT/VF (HR=0.60, p=0.016), a lower risk of VT/VF treated with ATP (HR=0.56, p=0.02), and a lower risk of VT/VF treated with shock (HR=0.44, p=0.007) (Figure). The risk of mortality was similar between men and women (HR=0.78, p=0.421). Conclusion: High-risk women implanted with an ICD or a CRT-D in the RAID trial were found to be at a significantly lower risk of VT/VF/death, VT/VF, VT/VF requiring ATP or shock when compared to men. However, both men and women had a similar risk of mortality.