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BACKGROUND: Some but not all prior studies have shown that women receiving aprimary prophylactic implantable cardioverter defibrillator (ICD) have a lowerrisk of death and appropriate shocks than men.  PURPOSE: To evaluate the effect of gender on the risk of appropriate shock,all-cause mortality and inappropriate shock in contemporary studies of patientsreceiving a primary prophylactic ICD.  DATA SOURCE: PubMed, LIVIVO, Cochrane CENTRAL between 2010 and 2016.  STUDY SELECTION: Studies providing at least 1 gender-specific risk estimatefor the outcomes of interest.  DATA EXTRACTION: Abstracts were screened independently for potentiallyeligible studies for inclusion. Thereby each abstract was reviewed by at leasttwo authors.  DATA SYNTHESIS: Out of 680 abstracts retained by our search strategy, 20studies including 46'657 patients had gender-specific information on at leastone of the relevant endpoints. Mean age across the individual studies variedbetween 58 and 69 years. The proportion of women enrolled ranged from 10% to30%. Across 6 available studies, women had a significantly lower risk of firstappropriate shock compared with men (pooled multivariable adjusted hazard ratio0.62 (95% CI [0.44; 0.88]). Across 14 studies reporting multivariable adjustedgender-specific hazard ratio estimates for all-cause mortality, women had alower risk of death than men (pooled hazard ratio 0.75 (95% CI [0.66; 0.86]).There was no statistically significant difference for the incidence of firstinappropriate shocks (3 studies, pooled hazard ratio 0.99 (95% CI [0.56;1.73]).  CONCLUSION: In this large contemporary meta-analysis, women had asignificantly lower risk of appropriate shocks and death than men, but asimilar risk of inappropriate shocks. These data may help to select patientswho benefit from primary prophylactic ICD implantation.

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Gender differences in appropriate shocks and mortality among patients  with primary prophylactic implantable cardioverter-defibrillators: Systematic  review and meta-analysis