Key result
The addition of dual chamber pacing to ICDs stands to potentially benefit approximately 53% of ICD recipients based on pacing indications, heart failure, or atrial fibrillation history.
Observational (n=253)
No
Approximately half of patients receiving ICDs have potential indications for dual chamber pacing, highlighting a significant clinical need for dual chamber capable devices.
Should not yet change device selection; leaves open need for RCTs to assess outcomes.
UNLABELLED: Bradycardia support by ICDs has been limited to fixed rate, ventricular pacing. Concomitant placement of a pacemaker and an ICD exposes a patient to potentially life-threatening device interactions. ICDs capable of dual chamber pacing have recently become available. The number of ICD recipients who stand to benefit from the addition of dual chamber pacing is debated, but no data have addressed this question. This retrospective study analyzed all patients who received nonthoractomy ICD system placement at the Mayo Clinic in Rochester, MN between March 1991 and October 1996 in order to determine the proportion of patients in whom a dual chamber pacing ICD may be indicated. DEFINITIONS: (1) Definitely indicated = pacemaker present at ICD implant or NASPE Class I pacing indication; (2) Probably indicated = NASPE Class II pacing indication, NYHA Functional Class III or IV, or history of systolic congestive heart failure; (3) Possibly indicated = history of paroxysmal atrial fibrillation or an ejection fraction < or = 20%. The results were that nonthoracotomy ICDs were placed in 253 patients. A dual chamber ICD would have been definitely indicated in 11% of the study group, probably indicated in 28%, and possibly indicated in 14%. Chronic atrial fibrillation was present at ICD implant in 6.7% of patients and developed in 0.9%/yr during follow-up. The addition of dual chamber pacing to ICDs stands to potentially benefit approximately half (53%) of ICD recipients. These data do not address all patients who may benefit from dual chamber sensing.
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Best et al. (1999) conducted an observational in Implantable Cardioverter Defibrillator (ICD) recipients (n=253). Dual chamber pacing ICD was evaluated on Proportion of patients in whom a dual chamber pacing ICD may be indicated. The addition of dual chamber pacing to ICDs stands to potentially benefit approximately 53% of ICD recipients based on pacing indications, heart failure, or atrial fibrillation history.
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