Single chamber implantable cardioverter defibrillator compared to dual chamber implantable cardioverter defibrillator: less is more! Data from the German Device Registry
Authors:
Harilaos Bogossian, Gerrit Frommeyer, Matthias Hochadel, Hüseyin Ince, Stefan G. Spitzer, Lars Eckardt, Sebastian K. G. Maier, Thomas Kleemann, Johannes Brachmann, Christoph Stellbrink, Bernd-Dieter Gonska, Stefan Kääb, Jochen Senges, Bernd Lemke
In patients with high risk for sudden cardiac death the implantation of a defibrillator is an established treatment. However the benefits and risks for patients in accordance to the number of the leads are not clear. Even in the current guidelines a recommendation to this question is missing. We analyzed advantage and disadvantages of single-chamber implantable cardioverter defibrillators (VVI-ICD) versus dual-chamber implantable cardioverter defibrillators (DDD-ICD) in the prospective German Device Registry.
Methods
The data of 2240 patients who underwent ICD implantation in 45 German Centers between January 2007 and March 2011 were included in a prospective device registry (VVI: n = 1629, male = 1358, EF = 34% ± 13%; DDD: n = 611, male = 491, EF = 35% ± 14%).
Results
The in-hospital complications were significantly higher in the DDD-ICD group with higher revision/device complication rates (3.0% vs. 1.2%; p = 0.003) but also higher mortality rate (1.0% vs. 0.1%; p < 0.001). Regarding the adjusted data at 1-year follow-up DDD-ICD caused more device revisions, but no difference in rehospitalization and mortality.
Conclusion
It is still unclear whether DDD-ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function. Our data show that the decision of the operator to choose a DDD-ICD in these patients must be taken very carefully. By choosing a DDD-ICD the patient is exposed to a significantly higher periprocedural complication rate and higher in-hospital mortality. In absence of relevant bradycardias implantation of a DDD-ICD is not justified.
Single chamber implantable cardioverter defibrillator compared to dual chamber implantable cardioverter defibrillator: less is more! Data from the German Device Registry
Authors
Harilaos Bogossian Gerrit Frommeyer Matthias Hochadel Hüseyin Ince Stefan G. Spitzer Lars Eckardt Sebastian K. G. Maier Thomas Kleemann Johannes Brachmann Christoph Stellbrink Bernd-Dieter Gonska Stefan Kääb Jochen Senges Bernd Lemke