Sudden death in men versus women with heart failure

Abstract

Purpose of review: Sudden cardiac death (SCD) represents the most feared complication of heart failure (HF). This review intends to provide insight on our current knowledge of sex-differences in SCD mechanisms, prevention, and management in HF patients. Recent findings: Women with HF present better prognosis than men and have a lower incidence of SCD, irrespective of the presence of ischemic heart disease and age. The influence of sex hormones, sex differences in intracellular calcium handling, and a differential myocardial remodeling may explain such gap between men and women. Both HF drugs and ventricular arrhythmias ablation seem also useful for the management of women at risk of SCD, but special care must be taken with the use of antiarrhythmic QT prolonging drugs. However, implantable cardioverter defibrillator (ICD) use has not shown to be equally effective in women than men. Summary: Sex-specific recommendations regarding SCD in HF are still lacking due to the scarcity of information and under-representation of women in clinical trials. Further investigation is required to provide specific risk stratification models in women. Cardiac magnetic resonance imaging, genetics development, and personalized medicine will probably play an increasing role in this evaluation.