June 19, 2013Journal of Cardiovascular Electrophysiology
Clinical Impact, Safety, and Efficacy of Single‐ versus Dual‐Coil ICD Leads in MADIT‐CRT
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Why the study?
Does the use of single-coil ICD leads compared to dual-coil ICD leads improve safety and efficacy in patients with cardiomyopathy and LVEF ≤30%?
Population
1,783 patients with ischemic or nonischemic cardiomyopathy, LVEF ≤30%, and prolonged interventricular…
Comparison
Single-coil implantable cardioverter-defibrillato… vs Dual-coil implantable cardioverter-defibrillator…
Design
Cohort, Adjudicated by an independent mortality committee blinded to clinical…
Follow-up
mean 3.3 years (40 months)
Authors
Discussion
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Implication
Comparable outcomes with single- versus dual-coil leads in this cohort; supports single-coil use but leaves open randomized confirmation.
Key Points
- To evaluate the defibrillation threshold, shock efficacy, complication rates, and clinical outcomes of single- versus dual-coil ICD leads in patients enrolled in MADIT-CRT.
- Assessed defibrillation threshold (DFT) at implantation and first shock efficacy among patients receiving single- versus dual-coil ICD leads in the MADIT-CRT trial.
- Evaluated risks of atrial tachyarrhythmias, all-cause mortality, short-term (< 30 days), and long-term complications over a mean follow-up of 3.3 years.
- Dual-coil ICD leads had lower DFTs than single-coil leads (17.6 ± 5.8 J vs 19.4 ± 6.1 J, P < 0.001), but first shock efficacy was similar between dual- and single-coil leads (89.6% vs 92.3%, P = 1.00).
- No significant difference was observed for atrial tachyarrhythmias (HR = 1.57, 95% CI: 0.81–3.02, P = 0.18) or all-cause mortality (HR = 1.10, 95% CI: 0.58–2.07, P = 0.77).
- Complication rates were comparable for short-term (HR = 0.96, 95% CI: 0.56–1.65, P = 0.88), long-term procedure-related (HR = 0.99, 95% CI: 0.62–1.59, P = 1.00), and long-term lead-related events (HR = 1.2, 95% CI: 0.5–2.9, P = 0.68).
Structured PICO
Does the use of single-coil ICD leads compared to dual-coil ICD leads improve safety and efficacy in patients with cardiomyopathy and LVEF ≤30%?
P
Population
1,783 patients with ischemic or nonischemic cardiomyopathy, LVEF ≤30%, and prolonged interventricular conduction delay (QRS >130 ms) enrolled in the MADIT-CRT trial.
I
Intervention
Single-coil implantable cardioverter-defibrillator (ICD) lead
C
Comparator
Dual-coil implantable cardioverter-defibrillator (ICD) lead
O
Outcome
Defibrillation threshold (DFT) at implantation and first shock efficacy
Single-coil ICD leads demonstrate similar efficacy, safety, and clinical outcomes compared to dual-coil leads, supporting their favorable use in most patients despite slightly higher defibrillation thresholds.
Limitations
- Nonrandomized fashion contributing to potential bias
- Shorter follow-up time in single-coil group
- Lack of programmed first shock energy data
- Small sample size in the single-coil arm
Cite This Study
Kutyifa et al. (2013) studied this question.
Topics
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