Gender differences in pacemaker therapy: reply

We read with great interest the comments made by Professor Irnich. Our data are in accordance with his findings made in the mid-1990s, namely that older women above the age of 80 receive more single-chamber ventricular devices compared with men in the same age. ^1–3 Irnich speculates about three reasons for this:So, despite the interesting points made by Irnich, a reliable explanation is still lacking.

• With increasing age, the quality of mode selection decreases: as our data show, this is true for both genders, but does not explain the gender difference observed.

• Quality of mode selection decreases with decreasing implantation numbers: we analysed this possibility in our paper as the database included 721 implantations being performed in 20 centres with less than 20 implantations per year. In those, the gender differences were more accentuated with men receiving 45.2% VVI devices and women receiving those in 60.4% ( P   <  0.01). Nevertheless, analysing the remaining centres with higher implantation rates revealed still significant differences: men 33.4% VVI implantations vs. women 38.6% VVI implantations ( P   <  0.01). Thus, it remains unclear whether this explanation is valid.

• Women aged >80 years are predominantly treated in smaller clinics: we are not aware of data supporting this possibility and we did not analyse our database regarding this topic.

Finally, it was not the aim of our study to assess the pacemaker implantation rate in the community, as we analysed a patient cohort that has had already received a device. Nevertheless, it is well known that the incidence of certain diseases is gender-dependent. ⁴ Thus, we do not know if men have more bradycardias requiring pacemaker implantation or if there is an overuse of pacemakers in men, or a mixture of both.

Conflict of interest: none declared.

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