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Comparative Study
. 2017 Nov 9;6(11):e006937.
doi: 10.1161/JAHA.117.006937.

Comparison of Inappropriate Shocks and Other Health Outcomes Between Single- and Dual-Chamber Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter-Defibrillators

Pamela N Peterson  1   2   3 , Robert T Greenlee  4   5 , Alan S Go  6   7   8 , David J Magid  2   3 , Andrea Cassidy-Bushrow  9 , Romel Garcia-Montilla  4 , Karen A Glenn  3 , Jerry H Gurwitz  10 , Stephen C Hammill  11 , John Hayes  4 , Alan Kadish  12 , Kristi Reynolds  13 , Param Sharma  4 , David H Smith  14 , Paul D Varosy  2   3   15 , Humberto Vidaillet  4 , Chan X Zeng  3 , Sharon-Lise T Normand  16   17 , Frederick A Masoudi  2   3
Affiliations
Comparative Study

Comparison of Inappropriate Shocks and Other Health Outcomes Between Single- and Dual-Chamber Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter-Defibrillators

Pamela N Peterson et al. J Am Heart Assoc. .

Abstract

Background: In US clinical practice, many patients who undergo placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death receive dual-chamber devices. The superiority of dual-chamber over single-chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compare risk of adverse outcomes, including inappropriate shocks, between single- and dual-chamber ICDs for primary prevention.

Methods and results: We identified patients receiving a single- or dual-chamber ICD for primary prevention who did not have an indication for pacing from 15 hospitals within 7 integrated health delivery systems in the Longitudinal Study of Implantable Cardioverter-Defibrillators from 2006 to 2009. The primary outcome was time to first inappropriate shock. ICD shocks were adjudicated for appropriateness. Other outcomes included all-cause hospitalization, heart failure hospitalization, and death. Patient, clinician, and hospital-level factors were accounted for using propensity score weighting methods. Among 1042 patients without pacing indications, 54.0% (n=563) received a single-chamber device and 46.0% (n=479) received a dual-chamber device. In a propensity-weighted analysis, device type was not significantly associated with inappropriate shock (hazard ratio, 0.91; 95% confidence interval, 0.59-1.38 [P=0.65]), all-cause hospitalization (hazard ratio, 1.03; 95% confidence interval, 0.87-1.21 [P=0.76]), heart failure hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.72-1.21 [P=0.59]), or death (hazard ratio, 1.19; 95% confidence interval, 0.93-1.53 [P=0.17]).

Conclusions: Among patients who received an ICD for primary prevention without indications for pacing, dual-chamber devices were not associated with lower risk of inappropriate shock or differences in hospitalization or death compared with single-chamber devices. This study does not justify the use of dual-chamber devices to minimize inappropriate shocks.

Keywords: defibrillator shocks; implantable cardioverter‐defibrillators; outcomes research.

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Figures

Figure 1
Figure 1
Assembly of study cohort of adults receiving single‐ vs dual‐chamber implantable cardioverter‐defibrillator (ICD) therapy for primary prevention of sudden cardiac death and no indication for pacing.
Figure 2
Figure 2
Cumulative incidence curves of time to each outcome by device type. ICD indicates implantable cardioverter‐defibrillator.
See this image and copyright information in PMC

References

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