Dual-Chamber Versus Single-Chamber Detection Enhancements for Implantable Defibrillator Rhythm Diagnosis

Abstract

Background-Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear. Methods and Results-Subjects with a clinical indication for ICD (nϭ400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single-or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42% of the episodes in the single-chamber arm and 69% of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5% in both groups) and early study withdrawal (14% single-chamber, 11% dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5% in the single-chamber detection arm compared with 30.9% in the dual-chamber arm.

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…Clinical trials and simulated testing of induced arrhythmias that compared single-vs dual-chamber discriminators have reported inconsistent results [10,33,[137][138][139]. Two meta-analyses found no superiority of dual-chamber ICDs in terms of mortality or inappropriate therapies [11,140].…”

Overview of implantable cardioverter defibrillator and cardiac resynchronisation therapy in heart failure management

“…Some reports suggested that the dual-chamber ICD provided clinical benefits in arrhythmia differentiation, prevention of inappropriate ICD therapy and patients who required pacing for bradyarrhythmias. (25)(26)(27)(28)(29) However, Dewland et al pointed out that complications were more frequent during the implantation of dual-versus single-chamber ICDs (3.17% vs. 2.11%; p < 0.001), with a higher in-hospital mortality (0.40% vs. 0.23%; p < 0.001). (24) Taking into account existing best evidence, American and European guidelines (19,30) …”

Efficacy and Limitations of Tachycardia Detection Interval Guided Reprogramming for Reduction of Inappropriate Shock in Implantable Cardioverter-Defibrillator Patients

“…19,20) Several studies have reported that dual chamber ICD decrease inappropriate therapies. 21,22) Because the dual chamber ICD can record atrial and ventricular intracardiac electrograms, a dual chamber ICD can diagnose tachy-arrhythmias more accurately than a single chamber ICD. In the present study, the actual percentage of inappropriate therapy was smaller in dual chamber ICD than single chamber ICD, but this point of "dual/ single chamber" was not an independent predictor in our evaluation.…”