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Home All Specialties Cardiology

Dual-chamber ICDs fail to offer benefit over single chamber ICDs

bys25qthea
May 14, 2013
in Cardiology, Chronic Disease
Reading Time: 2 mins read
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Image: PD

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.

Click to read the study, published today, in JAMA

Relevant Reading: Variation in use of dual-chamber implantable cardioverter defibrillators: results from the national cardiovascular data registry

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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

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain. 

Tags: cardiologydefibrillatorshealthheartICD
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