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Meta-Analysis
. 2018 Oct 1;20(10):1621-1629.
doi: 10.1093/europace/euy183.

Single vs. dual chamber implantable cardioverter-defibrillators or programming of implantable cardioverter-defibrillators in patients without a bradycardia pacing indication: systematic review and meta-analysis

Emily P Zeitler  1   2 , Gillian D Sanders  2 , Kavisha Singh  3 , Ruth Ann Greenfield  4 , Anne M Gillis  5 , Bruce L Wilkoff  6 , Jonathan P Piccini  1   2 , Sana M Al-Khatib  1   2
Affiliations
Meta-Analysis

Single vs. dual chamber implantable cardioverter-defibrillators or programming of implantable cardioverter-defibrillators in patients without a bradycardia pacing indication: systematic review and meta-analysis

Emily P Zeitler et al. Europace. .

Abstract

Aims: Implantable cardioverter-defibrillators (ICDs) are key in the prevention of sudden cardiac death, but outcomes may vary by type of device or programming [single chamber (SC) vs. dual chamber (DC)] in patients without a bradycardia pacing indication. We sought to meta-analyse patient outcomes of randomized trials of SC vs. DC devices or programming.

Methods and results: We searched PubMed, Embase, Scopus, Web of Science, and Cochrane trials databases for relevant studies excluding those published before 2000, involving children, or not available in English. Endpoints included mortality, inappropriate ICD therapies, and implant complications. Endpoints with at least three reporting studies were meta-analysed. We identified eight studies meeting inclusion criteria representing 2087 patients with 16.1 months mean follow-up. Mean age was 62.7 years (SD 1.92); in six studies reporting sex, most patients were male (85%). Comparing patients with a SC or DC ICD or programming, we found similar rates of mortality [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.54-1.68; P = 0.86] and inappropriate therapies (OR 1.46, 95% CI 0.97-2.19; P = 0.07) in five and six studies, respectively. In three studies of SC vs. DC ICDs (but not programming) rates of pneumothorax and lead dislodgement were not different (OR 2.12, 95% CI 0.18-24.72; P = 0.55 and OR 0.87, 95% CI 0.32-2.47; P = 0.83, respectively).

Conclusion: In this meta-analysis of randomized controlled trials comparing SC vs. DC ICD device or programming, there was no significant difference in inappropriate therapies, mortality, pneumothorax, or lead dislodgement. Future studies should compare these devices over longer follow-up and in specific patient populations.

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Figures

Figure 1
Figure 1
QUORUM diagram outlining the identification and inclusion of studies in this meta-analysis. CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator.
Figure 2
Figure 2
Forest plot for mortality in five studies reporting the outcome (A) overall, (B) randomized by programming, and (C) randomized by device type. CI, confidence interval; DC, dual chamber; SC, single chamber.
Figure 3
Figure 3
Forest plot for inappropriate therapies in six studies reporting the outcome (A) overall, (B) randomized by programming, and (C) randomized by device type. CI, confidence interval; DC, dual chamber; SC, single chamber.
Figure 4
Figure 4
Forest plot for pneumothorax in three studies reporting the outcome. CI, confidence interval.
Figure 5
Figure 5
Forest plot for lead dislodgement in three studies reporting the outcome. CI, confidence interval.
See this image and copyright information in PMC

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