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It helps us to continually improve our products. Wo men are less likely to receive cardiac resynchronisation therapy CRT , yet accumulating evidence suggests that they derive more benefit than men. This review summarises existing literature elucidating why sex-specific differences in CRT outcome exist. First it is demonstrated that among CRT candidates, women exhibit different risk factors resulting in better heart failure prognosis, irrespective of CRT. Second, women more often display factors associated with good response to CRT, such as non-ischaemic cardiomyopathy with lower scar burden and left bundle branch block at shorter QRS duration, possibly due to smaller heart size.
Whether differences in CRT outcome can be attributed to these factors or if, after correction, a true sex difference exists, remains a topic of debate. Over the past years, several reports have drawn attention to the need to consider sex-specific differences in cardiac resynchronisation therapy CRT.
Most importantly, there is growing concern on the underrepresentation of women in CRT landmark trials which laid the foundation for present guidelines. Although these cut-off values were derived from landmark trials with predominantly male subjects, the same criteria are currently used for women. Following these criteria, women are less likely to receive CRT, yet accumulating evidence suggests that they derive more benefit than men.
Previous review-reports advocated for the existence of this sex paradox and called for new sex-specific guidelines. This review summarises existing literature elucidating why sex-specific differences in CRT may exist.
