Clinical Impact, Safety, and Efficacy of Single‐ versus Dual‐Coil ICD Leads in MADIT‐CRT

Utilization trends and clinical outcomes in patients implanted with a single- vs a dual-coil implantable cardioverter-defibrillator lead: Insights from the ALTITUDE Study

“…Our findings support the conclusions of previous smaller studies, suggesting no difference in first shock success between single-and dual-coil lead systems, [7][8][9] with more power for definitive conclusions owing to the larger number of patients in our study. Although small, older studies 4-6 have suggested statistically significant differences between single-and dual-coil lead systems in the amount of defibrillation energy necessary to successfully convert ventricular arrhythmias.…”

“…First shock efficacy was similar between dual-and single-coil ICD leads (89.6% vs 92.3%; P ¼ 1.00), as was risk of all-cause mortality (HR 1.10; 95% CI 0.58-2.07; P ¼ .77). 9 Similarly, in an ICD registry study of 269 patients implanted with a single-coil lead and 5155 patients implanted with a dual-coil lead, single shock efficacy for conversion of ventricular arrhythmias was similar in age-and left ventricular ejection fraction-matched patients implanted with a single-coil lead (17 of 20 arrhythmias converted [85%]) vs a dual-coil lead (70 of 80 arrhythmias converted [87.3%]). 7 Taken together, these studies suggest that there is no clinically meaningful increased risk of adverse events in patients implanted with a single-vs a dual-coil ICD lead, but limitations to either controlled clinical trial settings or smaller numbers necessitate a larger real-world study with sufficient power for more definitive conclusions.…”

“…Existing published data representing less than 1000 single-coil lead implants have limited value due to small sample size and subgroup analyses. [7][8][9] In a subanalysis of the Sudden Cardiac Death in Heart Failure Trial, 30% of patients implanted with an ICD (246 of 809) were implanted with a single-coil lead. Overall, mortality (21.5% for single coil vs 19.4% for dual coil) and first shock efficacy (91.9% for single coil vs 82.2% for dual coil) were similar.…”

“…[4][5][6] Higherenergy devices in modern-day practice may make small differences in defibrillation thresholds between single-and dual-coil ICD lead systems less clinically meaningful. [7][8][9] Moreover, the more complex lead design of a dual-coil ICD lead may be associated with lead-related complications such as lead fracture, insulation problems, and fibrotic adhesions complicating lead extraction. 10,11 However, a large real-world contemporary evaluation of trends in single-vs dual-coil ICD lead implantation as well as potential differences in clinical outcomes in these patients has not been performed previously.…”

The subcutaneous implantable cardioverter-defibrillator: pros and cons

“…These rates are comparable to those reported with TV-ICD devices [35,36]. Mean DFT thresholds were 36.6 ± 19.8 J versus 11.1 ± 8.5 J for the TV-ICD devices [22].…”