9 research outputs found
Singleâ Versus DualâChamber Implantable CardioverterâDefibrillator for Primary Prevention of Sudden Cardiac Death in the United States
Background Routine addition of an atrial lead during an implantable cardioverterâdefibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of singleâ versus dualâchamber ICD implantations in these patients. Methods and Results Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primaryâprevention ICD implantation in the United States between 2015 and 2019. Sociodemographic and clinical characteristics, as well as inâhospital complications, were analyzed. Multivariable logistic regression was used to identify predictors of inâhospital complications. An estimated total of 15â940 patients, underwent ICD implantation for primary prevention of sudden cardiac death during the study period, 8860 (55.6%) received a dualâchamber ICD. The mean age was 64âyears, and 66% were men. Inâhospital complication rates in the dualâchamber ICD and singleâchamber ICD group were 12.8% and 10.7%, respectively (P<0.001), driven by increased rates of pneumothorax/hemothorax (4.6% versus 3.4%; P<0.001) and lead dislodgement (3.6% versus 2.3%; P<0.001) in the dualâchamber ICD group. Multivariable analyses confirmed atrial lead addition as an independent predictor for âany complicationsâ (odds ratio [OR], 1.1 [95% CI, 1.0â1.2]), for pneumo/hemothorax (odds ratio, 1.1 [95% CI, 1.0â1.4]), and for lead dislodgement (odds ratio, 1.3 [95% CI, 1.1â1.6]). Conclusions Despite lack of evidence for clinical benefit, dualâchamber ICDs are implanted for primary prevention of sudden cardiac death in a majority of patients who do not have pacing indication. This practice is associated with increased risk of periprocedural complications. Avoidance of routine implantation of atrial leads will likely improve safety outcomes