Key result
Dual-chamber ICDs linked to ~40% higher odds of in-hospital complications vs single-chamber devices.
Why the study?
Most patients in ICD efficacy trials received single-chamber devices. Although dual-chamber ICDs offer theoretical advantages, their clinical superiority has not been conclusively proven and they may increase complications.
Does dual-chamber ICD implantation increase in-hospital complication rates and mortality compared with single-chamber ICD implantation in a real-world registry population?
Cohort (n=104,049)
Yes
Does dual-chamber ICD implantation increase in-hospital complication rates and mortality compared with single-chamber ICD implantation in a real-world registry population?
Odds Ratio: 1.4 (95% CI 1.28–1.52)
Absolute Event Rate: 3.17% vs 2.11%
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Until now, our only option to obtain important and useful atrial signal information from patients undergoing defibrillator implantation has been to implant a separate atrial lead. Implanting multiple leads in the heart has been shown to increase the risk of complications, and the use of dual-chamber devices in patients without a clear indication for the additional atrial lead has received a great deal of attention in recent months. Until now, my approach for patients who do not require atrial pacing has been to implant single-chamber ICDs.”
In a large real-world registry cohort, dual-chamber ICD implantation was associated with significantly higher odds of periprocedural complications and in-hospital mortality compared to single-chamber ICD selection.
Objectives The aim of this study was to compare single- versus dual-chamber implantable cardioverter-defibrillator (ICD) implantation and complication rates in a large, real-world population. Background The majority of patients enrolled in ICD efficacy trials received single-chamber devices. Although dual-chamber ICDs offer theoretical advantages over single-chamber defibrillators, the clinical superiority of dual-chamber models has not been conclusively proven, and they may increase complications. Methods The National Cardiovascular Data Registry ICD Registry was used to examine the association between baseline characteristics and device selection in 104,049 patients receiving single- and dual-chamber ICDs between January 1, 2006, and December 31, 2007. A longitudinal cohort design was then used to determine in-hospital complication rates. Results Dual-chamber devices were implanted in 64,489 patients (62%). Adverse events were more frequent with dual-chamber than with single-chamber device implantation (3.17% vs. 2.11%, p < 0.001), as was the rate of in-hospital mortality (0.40% vs. 0.23%, p < 0.001). After adjusting for demographics, medical comorbidities, diagnostic test data, and ICD indication, the odds of any complication (odds ratio: 1.40; 95% confidence interval: 1.28 to 1.52; p < 0.001) and in-hospital mortality (odds ratio: 1.45; 95% confidence interval: 1.20 to 1.74; p < 0.001) were increased with dual-chamber versus single-chamber ICD implantation. Conclusions In this large, multicenter cohort of patients, dual-chamber ICD use was common. Dual-chamber device implantation was associated with increases in periprocedural complications and in-hospital mortality compared with single-chamber defibrillator selection.
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Dewland et al. (2011) conducted a cohort in Implantable cardioverter-defibrillator implantation (n=104,049). Dual-chamber implantable cardioverter-defibrillator vs. Single-chamber implantable cardioverter-defibrillator was evaluated on In-hospital adverse events (any complication) (OR 1.40, 95% CI 1.28-1.52, p=<0.001). Dual-chamber ICD implantation increased the odds of in-hospital complications (OR 1.40; 95% CI 1.28-1.52) and mortality (OR 1.45; 95% CI 1.20-1.74) compared with single-chamber ICDs.
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