Dual- versus single-coil implantable defibrillator leads: review of the literature

Abstract

The preferred use of dual-coil implantable defibrillator lead systems in current implantable defibrillator therapy is likely based on data showing statistically lower defibrillation thresholds with dual-coil defibrillator lead systems. The following review will summarize the clinical data for dual- versus single-coil defibrillator leads in the left and right pectoral implant locations, and will then discuss the clinical implications of single- versus dual-coil usage for atrial defibrillation, venous complications, and the risks associated with lead extraction. It will be noted that there are no comparative clinical studies on the use and outcomes of single- versus dual-coil lead systems in implantable defibrillator therapy over a long-term follow-up. The limited long-term reliability of defibrillator leads is a major concern in implantable defibrillator and cardiac resynchronization therapy. A simpler single-coil defibrillator lead system may improve the long-term performance of implanted leads. Furthermore, the superior vena cava coil is suspected to increase interventional risk in transvenous lead extraction. Therefore, the need for objective data on extractions and complications will be emphasized.

Postcardiac injury syndrome after cardiac implantable electronic device implantation

“…Since this is the largest study conducted on this subject to date (4989 patients included), it is likely that the frequency we present reflects the true incidence of PCIS. A further plausible explanation for this finding might be the use of more modern lead designs in our patients (2000-2014), in comparison with Sivakumaran et al (1991Sivakumaran et al ( -1999 or Greene et al (1989Greene et al ( -1990 [11,12,18]. Additional reasons for varying frequencies might be the lack of clear diagnostic criteria, as well as the fact that mild cases of PCIS are most likely never identified.…”

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

“…In fact, by nature of their design and need to accommodate an additional coil, dual-coil ICD leads have a more complicated lead design that may be more prone to insulation failure, lead fracture, or other abnormality requiring disconnection of that lead from the ICD system or extraction. 10 Instead, the attenuation of the point estimate with multivariable adjustment (including age in the model) may suggest that addition of other clinical confounding variables that were not available in our database would have further attenuated the association with a nonsignificant level. For example, if healthier patients were more likely to receive a single-coil lead (consistent with the fact that younger patients were more likely to receive a single-coil lead), it is possible that our observations may be explained by younger, more active individuals being prone to fracturing any lead type from more frequent/vigorous activity.…”

“…[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.…”

Jahresbericht 2014 des Deutschen Herzschrittmacher- und Defibrillatorregisters, Teil 2 – Implantierbare Kardioverter-Defibrillatoren (ICD)

“…2). Die Zahl Eingriffe pro Jahr im KH (Implantationen oder Aggregatwechsel) [5]. Bei Implantationen von links stellt überdies die Implantation einer zweiten Defibrillationselektrode, wenn eine Single-coil-Elektrode alleine nicht ausreicht, eine sehr erwägenswer-te Alternative dar, von der inzwischen aber immer seltener, nämlich nur noch in 1,2 % der Implantationen Gebrauch gemacht wird (.…”