Despite a recent decrease in use, dual-coil implantable cardioverter-defibrillators (ICDs) continue to represent the majority of implants in the U.S. and outnumber single-coil ICDs, according to a study published April 26 in JACC: Clinical Electrophysiology.

Sean D. Pokorney, MD, MBA, et al., used ACC's ICD Registry to analyze 435,772 patients across 1,690 hospitals who had an ICD implanted between April 2010 and December 2015. Results showed that while the use of dual-coil ICDs decreased from 86 percent to 55 percent within the five-year study period, the authors found that 72 percent of the total patient population received a dual-coil ICD.

They also classified the hospitals into three groups based on the frequency of the dual-coil ICD (low, decreasing and high). They found that hospitals in the low-use group were more likely to have ICDs implanted by electrophysiologists and more likely to perform extractions compared to high-use groups (90 percent vs. 46 percent; median 7 vs. median 2, p < 0.001).

The study authors highlight that certain patients at higher risk of arrhythmia (who are obese, African-American, have end-stage kidney disease and more) might benefit from dual-coil ICDs, however, patients' risk levels were not the deciding factor. "The data show that hospital-level factors are driving decision-making around ICDs instead of being more patient-focused," Pokorney states.

The authors conclude that moving forward, future research on ICDs should examine whether the decreasing trend in dual-coil ICDs can be associated with improved patient outcomes.

In a related editorial comment, Fred Kusumoto, MD, FACC, explains that "Although the study by Pokorney et al. does not supply any additional clinical insight into the relative merits of single- or dual-coil lead designs, it does provide fascinating insight into how changes in clinical practice occur in real life, particularly within a specialized field such as electrophysiology." He adds that, "the electrophysiology social network is well connected, and best practices in our field will continue to spread rapidly, generally without the requirement for active intervention programs. However, we must continue to be willing to share, to be open to change, and to develop new ties."

Keywords: African Americans, Arrhythmias, Cardiac, Defibrillators, Implantable, Electrophysiology, Kidney Failure, Chronic, Registries, Renal Insufficiency, Chronic, Social Support, National Cardiovascular Data Registries, ICD Registry

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