Inappropriate shocks in patients with ICDs: single chamber versus dual chamber

Abstract

Background: Despite the technological evolution of the implantable defibrillator, one of the questions that remains is the possible benefit of the dual chamber versus single chamber implantable cardioverter defibrillator (ICD) in reducing inappropriate shocks.

Objective: To evaluate which type of device provides fewer inappropriate shocks (dual chamber versus single chamber) in patients with implantable cardioverter defibrillators (ICDs).

Methods: Meta-analysis of randomized studies published in the literature comparing dual-chamber implantable cardioverter defibrillators to single chamber devices which have been known to cause, as an evaluated endpoint, inappropriate shocks.

Results: The dual-chamber implantable cardioverter showed no benefit in reducing the number of inappropriate shocks. In fact, the opposite was shown. In the analysis of fixed effects, the association tended to favor single-chamber implantable cardioverter defibrillators (OR = 1.53, CI 95%: 0.91-2.57), despite the absence of statistical significance (p = 0.11). We highlight the heterogeneity observed in the results (I² = 53%), which motivated a replication of the analysis using a model of random effects. However, significant differences remained in the occurrence of inappropriate shocks in both groups (OR = 1.1, 95% CI: 0.37-3.31; p = 0.86). To complement the analysis, we proceeded to perform sensitivity analysis, which showed that the exclusion of a study resulted in the lowest heterogeneity observed (I²=24%) and the association with inappropriate shocks significantly favored the single chamber cardiodefibrillator (OR = 1.91; 95% CI: 1.09-3.37; p = 0.27).

Conclusions: It was determined that there was no clear evidence of superiority of any of the devices evaluated.

Figure 2

Systematic Review Flowchart. ICD DR: dual chamber cardioverter defibrillator; ICD VR: single chamber cardioverter defibrillator; ICD: cardioverter defibrillator; CRT-D: cardiac resynchronization therapy and defibrillation; CRT-P: cardiac resynchronization therapy.

Figure 3

Forest Plot representing the model analysis of fixed effect model in the evaluation of the list of patients carriers of dual chamber cardioverter defibrillator versus single chamble cardioverter defibrillator in the occurrence of inappropriate shocks.

Figure 4

Forest Plot representing the model analysis of random effect in the evaluation of the list of patients. ICD DR: dual chamber cardioverter defibrillator; ICD VR: single chamber cardioverter defibrillator.