TY - JOUR
T1 - Single-Versus Dual-Chamber Implantable Cardioverter-Defibrillator for Primary Prevention of Sudden Cardiac Death in the United States
AU - Margolis, Gilad
AU - Hamuda, Nashed
AU - Kobo, Ofer
AU - Greener, Gabby Elbaz
AU - Amir, Offer
AU - Homoud, Munther
AU - Madias, Christopher
AU - Heist, Edwin Kevin
AU - Ruskin, Jeremy N.
AU - Kazatsker, Mark
AU - Roguin, Ariel
AU - Leshem, Eran
AU - Rozen, Guy
N1 - Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - BACKGROUND: Routine addition of an atrial lead during an implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of single-versus dual-chamber ICD implantations in these patients. METHODS AND RESULTS: Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primary-prevention ICD implantation in the United States between 2015 and 2019. Sociodemographic and clinical characteristics, as well as in-hospital complications, were analyzed. Multivariable logistic regression was used to identify predictors of in-hospital complications. An estimated total of 15 940 patients, underwent ICD implantation for primary prevention of sudden cardiac death during the study period, 8860 (55.6%) received a dual-chamber ICD. The mean age was 64 years, and 66% were men. In-hospital complication rates in the dual-chamber ICD and single-chamber ICD group were 12.8% and 10.7%, respectively (P<0.001), driven by increased rates of pneumothorax/hemothorax (4.6% versus 3.4%; P<0.001) and lead dislodgement (3.6% versus 2.3%; P<0.001) in the dual-chamber ICD group. Multivariable analyses confirmed atrial lead addition as an independent predictor for “any complications” (odds ratio [OR], 1.1 [95% CI, 1.0–1.2]), for pneumo/hemothorax (odds ratio, 1.1 [95% CI, 1.0–1.4]), and for lead dislodgement (odds ratio, 1.3 [95% CI, 1.1–1.6]). CONCLUSIONS: Despite lack of evidence for clinical benefit, dual-chamber ICDs are implanted for primary prevention of sudden cardiac death in a majority of patients who do not have pacing indication. This practice is associated with increased risk of periprocedural complications. Avoidance of routine implantation of atrial leads will likely improve safety outcomes.
AB - BACKGROUND: Routine addition of an atrial lead during an implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of single-versus dual-chamber ICD implantations in these patients. METHODS AND RESULTS: Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primary-prevention ICD implantation in the United States between 2015 and 2019. Sociodemographic and clinical characteristics, as well as in-hospital complications, were analyzed. Multivariable logistic regression was used to identify predictors of in-hospital complications. An estimated total of 15 940 patients, underwent ICD implantation for primary prevention of sudden cardiac death during the study period, 8860 (55.6%) received a dual-chamber ICD. The mean age was 64 years, and 66% were men. In-hospital complication rates in the dual-chamber ICD and single-chamber ICD group were 12.8% and 10.7%, respectively (P<0.001), driven by increased rates of pneumothorax/hemothorax (4.6% versus 3.4%; P<0.001) and lead dislodgement (3.6% versus 2.3%; P<0.001) in the dual-chamber ICD group. Multivariable analyses confirmed atrial lead addition as an independent predictor for “any complications” (odds ratio [OR], 1.1 [95% CI, 1.0–1.2]), for pneumo/hemothorax (odds ratio, 1.1 [95% CI, 1.0–1.4]), and for lead dislodgement (odds ratio, 1.3 [95% CI, 1.1–1.6]). CONCLUSIONS: Despite lack of evidence for clinical benefit, dual-chamber ICDs are implanted for primary prevention of sudden cardiac death in a majority of patients who do not have pacing indication. This practice is associated with increased risk of periprocedural complications. Avoidance of routine implantation of atrial leads will likely improve safety outcomes.
KW - complications
KW - implantable cardioverter-defibrillator
KW - single-versus dual-chamber
UR - http://www.scopus.com/inward/record.url?scp=85166761650&partnerID=8YFLogxK
U2 - 10.1161/JAHA.122.029126
DO - 10.1161/JAHA.122.029126
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C2 - 37522389
AN - SCOPUS:85166761650
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e029126
ER -