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Multicenter Study
. 2022 Mar 1;5(3):e223429.
doi: 10.1001/jamanetworkopen.2022.3429.

Trends in Use of Single- vs Dual-Chamber Implantable Cardioverter-Defibrillators Among Patients Without a Pacing Indication, 2010-2018

Ryan T Borne  1 , Paul Varosy  2   3 , Zhou Lan  4 , Frederick A Masoudi  2   5 , Jeptha P Curtis  4   6 , Daniel D Matlock  7   8 , Pamela N Peterson  2   9
Affiliations
Multicenter Study

Trends in Use of Single- vs Dual-Chamber Implantable Cardioverter-Defibrillators Among Patients Without a Pacing Indication, 2010-2018

Ryan T Borne et al. JAMA Netw Open. .

Abstract

Importance: Use of dual-chamber implantable cardioverter-defibrillator (ICD) systems among patients without a pacing indication is an example of low-value care given higher procedural risks, higher costs, and little evidence for benefit from an atrial lead. However, variation in the use of dual-chamber systems was present among patients without a pacing indication.

Objective: To examine the temporal trends and hospital variation in use of single- and dual-chamber ICD implantation among patients without a pacing indication undergoing first-time ICD implantation.

Design, setting, and participants: A multicenter cross-sectional study was conducted using the US National Cardiovascular Data Registry ICD Registry. A total of 266 182 patients undergoing initial implantation of a single- or dual-chamber transvenous ICD without a bradycardia pacing indication, class I or II cardiac resynchronization therapy indication, or history of atrial fibrillation or atrial flutter were included. The study was conducted from April 1, 2010, to December 31, 2018; data analysis was performed from October 19, 2020, to January 5, 2022.

Exposures: Implantation of a single- or dual-chamber ICD.

Main outcomes and measures: Temporal trends among patients undergoing single- vs dual-chamber ICDs were determined using the Cochran-Armitage trend test, and hospital-level variation using adjusted hospital median odds ratios was examined.

Results: A total of 266 182 patients (single-chamber ICD, 134 925; dual-chamber ICD, 131 257) were included in this analysis; mean (SD) age was 58.0 (14.0) years and 91 990 patients (68.2%) were men. The use of dual-chamber ICDs decreased from 64.7% (n = 15 694) in 2010 to 42.2% (n = 9762) in 2018 (P < .001). Adjusted for patient characteristics, the median hospital-level proportion of single-chamber ICDs increased from 42.9% (95% CI, 42.6%-45.0%) in 2010 to 50.0% (95% CI, 47.8%-51.0%) in 2018. The median odds ratio for the use of dual-chamber ICDs, adjusted for patient characteristics, was 1.6 (95% CI, 1.6-1.8) in 2010 and 1.5 (95% CI, 1.5-1.8) in 2018, indicating decreasing but persistent variation in use.

Conclusions and relevance: In this national study of US patients undergoing first-time ICD implantation without a clinical indication for an atrial lead, the use of dual-chamber devices decreased. However, institutional variability in the use of atrial leads persists, suggesting differences in individual or institutional cultures of real-world practice and opportunity to reduce this low-value practice.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Varosy reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Masoudi reported support through a contract with the American College of Cardiology for a stipend as chief scientific advisor, National Cardiovascular Data Registry (NCDR) outside the submitted work. Dr Curtis reported receiving salary support from the American College of Cardiology during the conduct of the study and having equity ownership in Medtronic outside the submitted work. Dr Peterson reported receiving grants from the National Heart, Lung, and Blood Institute outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Criteria for Analysis of Patients Receiving Implantable Cardioverter-Defibrillators (ICDs)
CRT indicates cardiac resynchronization therapy; CS, coronary sinus; LV, left ventricular.
Figure 2.
Figure 2.. Temporal Trends in Use of Single- and Dual-Chamber Implantable Cardioverter-Defibrillators (ICDs) From 2010 to 2018
Figure 3.
Figure 3.. Temporally Adjusted Hospital-Level Percentage for the Use of Single-Chamber Implantable Cardioverter-Defibrillators
The solid horizontal line indicates median; error bars, 95% CIs; circles, outliers.
See this image and copyright information in PMC

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