IMPORTANCE: Randomized trials of implantable cardioverter-defibrillators (ICDs) for primary prevention predominantly used single-chamber devices. In clinical practice, patients often receive dual-chamber ICDs, even without clear indications for pacing. The outcomes of dual- vs single-chamber devices are uncertain. OBJECTIVE: To compare outcomes of single- and dual-chamber ICDs for primary prevention of sudden cardiac death. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of admissions in the National Cardiovascular Data Registry's (NCDR) ICD registry from 2006-2009 that could be linked to Centers for Medicare & Medicaid Services fee-for-service Medicare claims data. Patients were included if they received an ICD for primary prevention and did not have a documented indication for pacing. MAIN OUTCOMES AND MEASURES: Adjusted risks of 1-year mortality, all-cause readmission, heart failure readmission, and device-related complications within 90 days were estimated with propensity-score matching based on patient, clinician, and hospital factors. RESULTS: Among 32,034 patients, 12,246 (38%) received a single-chamber device and 19,788 (62%) received a dual-chamber device. In a propensity-matched cohort, rates of complications were lower for single-chamber devices (3.51% vs 4.72%; P < .001; risk difference, -1.20 [95% CI, -1.72 to -0.69]), but device type was not significantly associated with 1-year mortality (unadjusted rate, 9.85% vs 9.77%; hazard ratio [HR], 0.99 [95% CI, 0.91 to 1.07]; P = .79), 1-year all-cause hospitalization (unadjusted rate, 43.86% vs 44.83%; HR, 1.00 [95% CI, 0.97-1.04]; P = .82), or hospitalization for heart failure (unadjusted rate, 14.73% vs 15.38%; HR, 1.05 [95% CI, 0.99-1.12]; P = .19). CONCLUSIONS AND RELEVANCE: Among patients receiving an ICD for primary prevention without indications for pacing, the use of a dual-chamber device compared with a single-chamber device was associated with a higher risk of device-related complications and similar 1-year mortality and hospitalization outcomes. Reasons for preferentially using dual-chamber ICDs in this setting remains unclear.
IMPORTANCE: Randomized trials of implantable cardioverter-defibrillators (ICDs) for primary prevention predominantly used single-chamber devices. In clinical practice, patients often receive dual-chamber ICDs, even without clear indications for pacing. The outcomes of dual- vs single-chamber devices are uncertain. OBJECTIVE: To compare outcomes of single- and dual-chamber ICDs for primary prevention of sudden cardiac death. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of admissions in the National Cardiovascular Data Registry's (NCDR) ICD registry from 2006-2009 that could be linked to Centers for Medicare & Medicaid Services fee-for-service Medicare claims data. Patients were included if they received an ICD for primary prevention and did not have a documented indication for pacing. MAIN OUTCOMES AND MEASURES: Adjusted risks of 1-year mortality, all-cause readmission, heart failure readmission, and device-related complications within 90 days were estimated with propensity-score matching based on patient, clinician, and hospital factors. RESULTS: Among 32,034 patients, 12,246 (38%) received a single-chamber device and 19,788 (62%) received a dual-chamber device. In a propensity-matched cohort, rates of complications were lower for single-chamber devices (3.51% vs 4.72%; P < .001; risk difference, -1.20 [95% CI, -1.72 to -0.69]), but device type was not significantly associated with 1-year mortality (unadjusted rate, 9.85% vs 9.77%; hazard ratio [HR], 0.99 [95% CI, 0.91 to 1.07]; P = .79), 1-year all-cause hospitalization (unadjusted rate, 43.86% vs 44.83%; HR, 1.00 [95% CI, 0.97-1.04]; P = .82), or hospitalization for heart failure (unadjusted rate, 14.73% vs 15.38%; HR, 1.05 [95% CI, 0.99-1.12]; P = .19). CONCLUSIONS AND RELEVANCE: Among patients receiving an ICD for primary prevention without indications for pacing, the use of a dual-chamber device compared with a single-chamber device was associated with a higher risk of device-related complications and similar 1-year mortality and hospitalization outcomes. Reasons for preferentially using dual-chamber ICDs in this setting remains unclear.
Authors: Stephen C Hammill; Mark S Kremers; Lynne Warner Stevenson; Paul A Heidenreich; Christine M Lang; Jeptha P Curtis; Yongfei Wang; Charles I Berul; Alan H Kadish; Sana M Al-Khatib; Ileana L Pina; Mary Norine Walsh; Michael J Mirro; Bruce D Lindsay; Matthew R Reynolds; Kathryn Pontzer; Laura Blum; Frederick Masoudi; John Rumsfeld; Ralph G Brindis Journal: Heart Rhythm Date: 2010-07-18 Impact factor: 6.343
Authors: Brian Olshansky; John D Day; Stephen Moore; Lawrence Gering; Murray Rosenbaum; Maureen McGuire; Scott Brown; Darin R Lerew Journal: Circulation Date: 2006-12-18 Impact factor: 29.690
Authors: Stephen C Hammill; Lynne Warner Stevenson; Alan H Kadish; Mark S Kremers; Paul Heidenreich; Bruce D Lindsay; Michael J Mirro; Martha J Radford; Yongfei Wang; Christine M Lang; Joel C Harder; Ralph G Brindis Journal: Heart Rhythm Date: 2007-07-25 Impact factor: 6.343
Authors: Bruce L Wilkoff; Peter J Kudenchuk; Alfred E Buxton; Arjun Sharma; James R Cook; Anil K Bhandari; Michael Biehl; Gery Tomassoni; Anna Leonen; Linette R Klevan; Alfred P Hallstrom Journal: J Am Coll Cardiol Date: 2009-03-10 Impact factor: 24.094
Authors: Andrew E Epstein; John P DiMarco; Kenneth A Ellenbogen; N A Mark Estes; Roger A Freedman; Leonard S Gettes; A Marc Gillinov; Gabriel Gregoratos; Stephen C Hammill; David L Hayes; Mark A Hlatky; L Kristin Newby; Richard L Page; Mark H Schoenfeld; Michael J Silka; Lynne Warner Stevenson; Michael O Sweeney; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Christopher E Buller; Mark A Creager; Steven M Ettinger; David P Faxon; Jonathan L Halperin; Loren F Hiratzka; Sharon A Hunt; Harlan M Krumholz; Frederick G Kushner; Bruce W Lytle; Rick A Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Lynn G Tarkington; Clyde W Yancy Journal: Circulation Date: 2008-05-15 Impact factor: 29.690
Authors: Daniel B Mark; Charlotte L Nelson; Kevin J Anstrom; Sana M Al-Khatib; Anastasios A Tsiatis; Patricia A Cowper; Nancy E Clapp-Channing; Linda Davidson-Ray; Jeanne E Poole; George Johnson; Jill Anderson; Kerry L Lee; Gust H Bardy Journal: Circulation Date: 2006-07-03 Impact factor: 29.690
Authors: Matthew R Reynolds; David J Cohen; Aaron D Kugelmass; Phillip P Brown; Edmund R Becker; Steven D Culler; April W Simon Journal: J Am Coll Cardiol Date: 2006-05-30 Impact factor: 24.094
Authors: Jesus Almendral; Fernando Arribas; Christian Wolpert; Renato Ricci; Pedro Adragao; Erik Cobo; Xavier Navarro; Aurelio Quesada Journal: Europace Date: 2008-04-07 Impact factor: 5.214
Authors: Sana M Al-Khatib; Melissa A Greiner; Eric D Peterson; Adrian F Hernandez; Kevin A Schulman; Lesley H Curtis Journal: Circ Arrhythm Electrophysiol Date: 2008-10
Authors: Ariel R Green; Bruce Leff; Yongfei Wang; Erica S Spatz; Frederick A Masoudi; Pamela N Peterson; Stacie L Daugherty; Daniel D Matlock Journal: Circ Cardiovasc Qual Outcomes Date: 2015-12-29
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Mohammed Shurrab; Amir Janmohamed; Jean-François Sarrazin; Felix Ayala-Paredes; Marcio Sturmer; Randall Williams; Satish Toal; Chris Lane; Kevin E Thorpe; Jeff S Healey; Eugene Crystal Journal: J Interv Card Electrophysiol Date: 2017-07-27 Impact factor: 1.900
Authors: Emily P Zeitler; Gillian D Sanders; Kavisha Singh; Ruth Ann Greenfield; Anne M Gillis; Bruce L Wilkoff; Jonathan P Piccini; Sana M Al-Khatib Journal: Europace Date: 2018-10-01 Impact factor: 5.214
Authors: Joseph S Ross; Jonathan Bates; Craig S Parzynski; Joseph G Akar; Jeptha P Curtis; Nihar R Desai; James V Freeman; Ginger M Gamble; Richard Kuntz; Shu-Xia Li; Danica Marinac-Dabic; Frederick A Masoudi; Sharon-Lise T Normand; Isuru Ranasinghe; Richard E Shaw; Harlan M Krumholz Journal: Med Devices (Auckl) Date: 2017-08-16