Reduced Risk for Inappropriate Implantable Cardioverter-Defibrillator Shocks With Dual-Chamber Therapy Compared With Single-Chamber Therapy

Abstract

Therapy with dual-chamber settings for ICD discrimination combined with algorithms for minimizing ventricular pacing was associated with reduced risk for inappropriate shock compared with single-chamber settings, without increases in mortality and morbidity. (Optimal Anti-Tachycardia Therapy in Implantable Cardioverter-Defibrillator [ICD] Patients Without Pacing Indications [OPTION]; NCT00729703).

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

“…The Optimal Anti-Tachycardia Therapy in Implantable Cardioverter-Defibrillator Patients Without Pacing Indications (OPTION) trial randomized 462 patients to single-or dual-chamber programming and noted inappropriate shock rates of 10.3% for single chamber vs 4.3% for dual chamber after 27 months (P¼ .015). Atrial lead-related complications were 1.3%, therapy was delivered from 170 bpm (VT) and 200 bpm (VF), and no difference in ventricular pacing percentage was noted [141]. Dual-chamber algorithms probably reduce the risk of underdetection compared with single-chamber algorithms because more than 80% of VTs with a ventricular rate greater than the atrial rate undergo no further analysis [103,124,125].…”

Clinical Outcomes of Single‐ versus Dual‐Chamber Implantable Cardioverter Defibrillators: Lessons from the Israeli ICD Registry

“…4 It is likely that advanced algorithms of dual-chamber devices might improve arrhythmia detection and reduce inappropriate therapy, but larger prospective trials with pre-specified device programming are still required to assess this hypothesis.…”

“…4 In contrast, the use of dual-chamber devices is associated with increased procedure length and higher costs. Furthermore, dual-chamber devices were shown to be associated with increased risk of complications such as pneumothorax, cardiac tamponade, and other mechanical complications requiring system revision.…”

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

“…Data on the results of these algorithms are mixed, with some studies demonstrating a decrease in the rate of inappropriate shocks in dual-chamber ICD patients, 76 and others finding no difference. 77 A meta-analysis on the subject was also equivocal, finding a small reduction in the total number of inappropriate shocks delivered in dual-chamber ICDs, but no reduction in the number of patients experiencing an episode of inappropriate shock.…”