Dual-Chamber Implantable Cardioverter-Defibrillator Selection Is Associated With Increased Complication Rates and Mortality Among Patients Enrolled in the NCDR Implantable Cardioverter-Defibrillator Registry

Aug 22, 2011
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Authors:
Dewland TA, Pellegrini CN, Wang Y, Marcus GM, Keung E, Varosy PD.
Citation:
J Am Coll Cardiol 2011;58:1007-1013.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Are dual-chamber implantable cardioverter-defibrillators (ICDs) associated with a higher risk of peri-implant complications compared to single-chamber ICDs?

Methods:

The data in this study were obtained from a national ICD registry. A dual-chamber ICD was implanted in 64,489 patients (mean age 67 years) and a single-chamber ICD was implanted in 39,560 patients (mean age 64 years). In-hospital complications were analyzed.

Results:

A guideline-based indication for pacing was present in 40% of dual-chamber ICD recipients. The complication rate was significantly higher in the dual-chamber group (3.2%) than in the single-chamber group (2.1%), as was the mortality rate (0.4% vs. 0.23%, respectively). The most common complications were hematoma and lead dislodgement, both of which were more frequent in the dual-chamber group than in the single-chamber group (0.9% vs. 0.7%, and 0.9% vs. 0.5%, respectively). After adjusting for comorbidities and other confounders, dual-chamber ICD implantation was associated with a 40% greater risk of complications and a 45% greater risk of mortality compared to single-chamber ICD implantation.

Conclusions:

Implantation of dual-chamber ICDs is associated with a 40% higher risk of complications compared to single-chamber ICDs.

Perspective:

Because more than 50% of the patients who received a dual-chamber ICD did not have a bradycardia indication for pacing, a dual-chamber pacemaker presumably often was implanted to detect atrial arrhythmias and allow for discrimination algorithms to avoid inappropriate ICD therapies. However, the studies that have evaluated the efficacy of discrimination algorithms have had mixed results. Given the higher risk of complications, including death, it may be appropriate to limit dual-chamber ICDs to patients who have an indication for pacing.

Keywords: Cardiology, Bradycardia, Hematoma, Defibrillators, Implantable


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