Biventricular ICDs had a significantly higher annual incidence of surgical revision for complications compared to single- and dual-chamber devices (11.8% vs 4.9% and 4.1%; RR 2.37, 95% CI 1.38-4.04).
Cohort (n=816)
Does biventricular ICD implantation increase the risk of surgical revision compared to single- or dual-chamber ICDs in ICD recipients?
Biventricular ICDs have a significantly higher rate of complications requiring surgical revision compared to single- and dual-chamber devices, primarily driven by lead-related issues.
Effect estimate: RR 2.37 (95% CI 1.38-4.04)
Absolute Event Rate: 11.8% vs 4.9%
p-value: p=0.002
AIMS: Implantable cardioverter defibrillator (ICD) technology has become more complex, particularly with respect to biventricular resynchronization devices. The incidence of hardware-related complications in single (SC)-, dual (DC)-, and triple (BiV)-chamber devices requiring surgical revision has not been investigated systematically. METHODS AND RESULTS: We analysed data from consecutive ICD recipients implanted between January 2000 and December 2007 with respect to the need of surgical re-intervention for device- or lead-related complications. Generator exchanges due to normal battery depletion were not considered. From 816 patients (81% male, 69% ischaemic cardiomyopathy, 48% secondary prevention ICDs) followed for 31 +/- 24 months (2118 cumulative patient-years), 98 patients underwent 110 revisions (5.2% per patient-year). Complications included lead-related revision procedures in 81 cases and generator-related problems in 29 cases. The annual incidence of surgical revision due to complications was 11.8% in BiV compared with 4.9% in SC and 4.1% in DC patients (P = 0.002). This higher revision rate was mainly caused by lead-related complications. Implantation of a BiV system was an independent risk factor of the need for surgical revision (relative risk 2.37, 95% confidence interval 1.38-4.04). CONCLUSION: Even with long-lasting operator experience, complications requiring surgical revision remain a clinically important problem of ICD therapy. The incidence of complications is significantly higher in BiV resynchronization devices than in SC and DC systems.
Duray et al. (Tue,) conducted a cohort in Implantable cardioverter defibrillator (ICD) recipients (n=816). Biventricular (BiV) ICD vs. Single-chamber (SC) and dual-chamber (DC) ICDs was evaluated on Surgical re-intervention for device- or lead-related complications (RR 2.37, 95% CI 1.38-4.04, p=0.002). Biventricular ICDs had a significantly higher annual incidence of surgical revision for complications compared to single- and dual-chamber devices (11.8% vs 4.9% and 4.1%; RR 2.37, 95% CI 1.38-4.04).