[Implantation of CRT/ICD in women with heart failure – do we have sufficient evidence?]

There are several gender differences in epidemiology, the course, prognosis and treatment of heart failure which is called the epidemic of 21st century. In women heart failure appears at a later age and this can be a sufficient reason for incidence of concomitant diseases. Clinical symptoms of heart failure in females are caused at a higher percentage by non-ischaemic cardiomyopathy and heart failure with preserved ejection fraction of the left ventricle. The history of development of current guidelines for ICD has significantly influenced different, gender-dependent access of patients to ICD implantation in prevention of sudden cardiac death. Women with heart failure are qualified for ICD less frequently than men. It seems that the existing disparities in utilization of ICD are significantly higher than sexdependent differences in the risk of sudden cardiac death. Most probably the guidelines for ICD will be improved only after establishment of the indications for ICD in patients with heart failure with preserved ejection fraction. Participation of females in CRT is significantly smaller despite the lack of separate indications for this mode of heart failure treatment. Women, however, demonstrate a greater improvement after CRT, especially as far as survival rate is concerned. A high rate of non-responders to CRT impels the search for its reason. Presently there is a considerable interest in morphology and duration of initial QRS. Including the parameter of “true” LBBB and more effective ways of describing mechanical dyssynchrony of the heart, with higher participation of women in CRT therapy, has the chance to decreasing the number of non-responders. Women are additionally at a greater risk of complications of endocardial lead implantation procedure as well as of late mechanical lead damage. This is a challenge for the producers of the devices and electrotherapy operators.