Comparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators

Abstract

BackgroundIn US clinical practice, many patients who undergo placement of an implantable cardioverter‐defibrillator (ICD) for primary prevention of sudden cardiac death receive dual‐chamber devices. The superiority of dual‐chamber over single‐chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compare risk of adverse outcomes, including inappropriate shocks, between single‐ and dual‐chamber ICDs for primary prevention.Methods and ResultsWe identified patients receiving a single‐ or dual‐chamber ICD for primary prevention who did not have an indication for pacing from 15 hospitals within 7 integrated health delivery systems in the Longitudinal Study of Implantable Cardioverter‐Defibrillators from 2006 to 2009. The primary outcome was time to first inappropriate shock. ICD shocks were adjudicated for appropriateness. Other outcomes included all‐cause hospitalization, heart failure hospitalization, and death. Patient, clinician, and hospital‐level factors were accounted for using propensity score weighting methods. Among 1042 patients without pacing indications, 54.0% (n=563) received a single‐chamber device and 46.0% (n=479) received a dual‐chamber device. In a propensity‐weighted analysis, device type was not significantly associated with inappropriate shock (hazard ratio, 0.91; 95% confidence interval, 0.59–1.38 [P=0.65]), all‐cause hospitalization (hazard ratio, 1.03; 95% confidence interval, 0.87–1.21 [P=0.76]), heart failure hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.72–1.21 [P=0.59]), or death (hazard ratio, 1.19; 95% confidence interval, 0.93–1.53 [P=0.17]).ConclusionsAmong patients who received an ICD for primary prevention without indications for pacing, dual‐chamber devices were not associated with lower risk of inappropriate shock or differences in hospitalization or death compared with single‐chamber devices. This study does not justify the use of dual‐chamber devices to minimize inappropriate shocks.

Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study

“…However, these potential benefits were not confirmed by randomized clinical trials. The benefits of reducing inappropriate therapy in dual chamber device is not very clear over single chamber device for primary and secondary prevention 28)29)30). Recent study reported that dual-chamber ICD showed an increased risk of periprocedural complications and generator replacement, whereas the risk of inappropriate shock is similar to the single-chamber ICD 31).…”

Considering Factors in the Single- Versus Dual-coil Lead Debate

“…6 Varying data exist regarding the inappropriate shock rates of single-coil and dual-coil devices, though a number of studies suggest there is no significant difference between the two. [7][8][9][10] However, the other aforementioned factors support the thought posed by Gul et al, 1 that perhaps single-coil ICDs should be considered first for implantation before dual-coil devices wherever appropriate.…”

Optimal Strategies to Reduce Inappropriate Implantable Cardioverter-defibrillator Shocks

“…16,17 In one large review, among patients who received an ICD for primary prevention without indications for pacing, dual-chamber devices were not associated with a lower risk of inappropriate shock or differences in hospitalization or death as compared with single-chamber devices. 18…”