Sex differences in selection of pacemakers: retrospective observational study

Objective: To evaluate the effect of patients’ sex on selection of pacemakers. Design: Retrospective univariate and multivariate analysis of a large database. Setting: German central pacemaker register. Subjects: Records collected at the register for 1992 and 1993 (n=31 913), covering 64% of all implantations in Germany. Main outcome measure: Probability of receiving a single chamber, dual chamber, or rate responsive pacemaker in relation to sex. Results: Univariate analysis showed that women were more likely to receive single chamber pacemakers and less likely to receive dual chamber or rate responsive systems than men. After demographic and clinical variables were controlled for, women were still more likely to receive a single chamber system (atrial pacing: odds ratio 0.89, 95% confidence interval 0.74 to 1.07; ventricular pacing: 0.85, 0.80 to 0.92) and less likely to receive a dual chamber (1.20, 1.12 to 1.30) or a rate responsive system (1.26, 1.17 to 1.37) than men. Conclusions: The data suggest sex differences in the selection of a pacemaker system which cannot be explained by the underlying cardiac disorder. Further research is needed to evaluate why guidelines for implanting pacemakers are not better adhered to.