1. Dual-chamber implantable cardioverter-defibrillators (ICDs) do not offer better outcomes with regard to mortality or readmission in the year following transplant.
2. Dual-chamber ICDs are associated with higher complication rates relative to single-chamber ICDs including increasing risk of complications requiring surgical revision.
Evidence Rating Level: 2 (Good)
Study Rundown: More complex dual-chamber implantable cardioverter-defibrillators (ICDs) offered no better clinical outcome as compared with the single-chamber ICD. Furthermore, dual-chamber devices were associated with higher complication rates. In practice, the need for dual-chamber pacing should be carefully considered. While this was a randomized study population and not the likely sicker general Medicare population, it raises interesting questions as to the purported advantages dual-chamber ICDs. While dual chambers ICDs have enhanced rhythm detection and thus fewer inappropriate shocks, future studies are called for to ascertain as to whether this can offset complication rates in certain populations.
In-Depth [retrospective cohort study]: From January 2006 to December 2009, 32034 eligible patients without a pacing indication receiving ICDs for primary prevention from 1270 hospitals were enrolled from the National Cardiovascular Data Registry’s ICD registry. Outcomes were assessed using linked CMS claims and included all-cause mortality, all-cause readmission and readmission for heart failure at 1 year. The dual-chamber ICD offered no better outcome as compared with the single-chamber ICD. Further, dual-chamber devices were associated with higher complication rates relative to single chamger ICD, including any complications within 90 days (p<0.001) and those requiring surgical revision (p<0.001).
By Mike Hoaglin and Rif Rahman
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