Prabhat Kumar1, Matthew Baker1, Anil K Gehi2. 1. Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: anil_gehi@med.unc.edu.
Abstract
OBJECTIVES: The purpose of this investigation was to conduct a meta-analysis of studies comparing defibrillation threshold (DFT) and outcomes with single-coil and dual-coil implantable cardioverter-defibrillator (ICD) systems. BACKGROUND: Use of dual-coil rather than single-coil defibrillator leads may lower the DFT with a transvenous ICD system; however, dual-coil ICDs may have higher lead-related complications. METHODS: Sixteen studies, each with more than 10 human subjects, that compared single-coil and dual-coil ICD systems were included for the final analysis after a comprehensive publication search using predefined search terms and additional search from cross-references. A test of heterogeneity, pooling, and meta-analysis of the data from the studies were performed using R statistical software. A random effects model was used for meta-analysis. RESULTS: Data pooled from 14 studies analyzed for difference in DFT showed an estimated difference in mean DFTs between single-coil and dual-coil ICDs of 0.81 J (95% confidence interval [CI]: 0.31 to 1.30 J), thus favoring dual-coil ICDs. However, pooled data from 5 studies revealed no difference in first-shock efficacy for dual-coil ICDs compared with single-coil ICDs (estimated overall odds ratio: 0.94; 95% CI: 0.49 to 1.78; p = 0.85). The all-cause mortality rate analyzed from 4 studies was lower in patients with single-coil ICDs (estimated hazard ratio: 0.91; 95% CI: 0.83 to 0.99). CONCLUSIONS: There was a marginal difference in the defibrillation threshold of transvenous ICDs between single-coil and dual-coil lead systems. However, first-shock efficacy was no different between the 2 groups, and patients with single-coil ICDs had favorable all-cause mortality rates on the basis of data from nonrandomized studies. Potential risks and benefits of single-coil and dual-coil ICD leads should be carefully weighed.
OBJECTIVES: The purpose of this investigation was to conduct a meta-analysis of studies comparing defibrillation threshold (DFT) and outcomes with single-coil and dual-coil implantable cardioverter-defibrillator (ICD) systems. BACKGROUND: Use of dual-coil rather than single-coil defibrillator leads may lower the DFT with a transvenous ICD system; however, dual-coil ICDs may have higher lead-related complications. METHODS: Sixteen studies, each with more than 10 human subjects, that compared single-coil and dual-coil ICD systems were included for the final analysis after a comprehensive publication search using predefined search terms and additional search from cross-references. A test of heterogeneity, pooling, and meta-analysis of the data from the studies were performed using R statistical software. A random effects model was used for meta-analysis. RESULTS: Data pooled from 14 studies analyzed for difference in DFT showed an estimated difference in mean DFTs between single-coil and dual-coil ICDs of 0.81 J (95% confidence interval [CI]: 0.31 to 1.30 J), thus favoring dual-coil ICDs. However, pooled data from 5 studies revealed no difference in first-shock efficacy for dual-coil ICDs compared with single-coil ICDs (estimated overall odds ratio: 0.94; 95% CI: 0.49 to 1.78; p = 0.85). The all-cause mortality rate analyzed from 4 studies was lower in patients with single-coil ICDs (estimated hazard ratio: 0.91; 95% CI: 0.83 to 0.99). CONCLUSIONS: There was a marginal difference in the defibrillation threshold of transvenous ICDs between single-coil and dual-coil lead systems. However, first-shock efficacy was no different between the 2 groups, and patients with single-coil ICDs had favorable all-cause mortality rates on the basis of data from nonrandomized studies. Potential risks and benefits of single-coil and dual-coil ICD leads should be carefully weighed.
Authors: Andrzej Ząbek; Krzysztof Boczar; Maciej Dębski; Mateusz Ulman; Roman Pfitzner; Robert Musiał; Jacek Lelakowski; Barbara Małecka Journal: Medicine (Baltimore) Date: 2019-07 Impact factor: 1.817