Background and aims <p>Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy with defibrillation-function (CRT-D) are widely used in patients with life-threatening arrhythmias or heart failure. We aim to investigate the impact of sex-specific differences on defibrillation-capable cardiac devices’ implantation and outcomes.</p> Methods <p>The German DEVICE registry is a prospective, multicentre database of ICD and CRT device implantation. A total of 5330 patients receiving a defibrillation-capable device were prospectively enrolled in 44 centres between March 2007 and February 2014 and followed for 17 (13, 23) months.</p> Results <p>A minority of patients in this registry was female 1017 (19.1%). The rate of CRT-D use among the defibrillator recipients was higher in women (32.4% vs. 28.0%; <i>p</i> = 0.006). The incidence of major periprocedural complications and in-hospital complications were higher in women (3.3% vs. 1.6%; <i>p</i> = 0.001 and 5.5% vs. 3.6%; <i>p</i> = 0.017, respectively). The 1-year all-cause mortality was 5.5% for women and 7.4% for men (<i>p</i> = 0.039), while the 1-year cardiovascular mortality was 4.1% and 6.2%, respectively (<i>p</i> = 0.012). Less women received device shocks during 1-year follow-up (10.7% vs. 13.8%; <i>p</i> = 0.023). Women receiving CRT-D had a lower non-device-related cardiovascular hospitalization rate than men.</p> <p>System revision until discharge, in-hospital death and non-fatal complications during follow-up were comparable for men and women. Similar rates of all-cause and cardiac rehospitalizations were found.</p> Conclusions <p>In this real-life patient cohort only a minority of patients was female. Female patients had a higher risk of major periprocedural complications and in-hospital complications but a lower all-cause and cardiovascular mortality. Less women experienced device-shocks during follow-up.</p> Graphical Abstract <p>Overview of the results</p> <p></p>