Harilaos Bogossian1,2, Gerrit Frommeyer3, Matthias Hochadel4, Hüseyin Ince5,6, Stefan G Spitzer7, Lars Eckardt3, Sebastian K G Maier8, Thomas Kleemann9, Johannes Brachmann10, Christoph Stellbrink11, Bernd-Dieter Gonska12, Stefan Kääb13, Jochen Senges4, Bernd Lemke14. 1. Department of Cardiology and Angiology, Klinikum Lüdenscheid, Märkische Kliniken GmbH, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany. Harilaos.bogossian@klinikum-luedenscheid.de. 2. Universität Witten/Herdecke, Witten, Germany. Harilaos.bogossian@klinikum-luedenscheid.de. 3. Klinik für Kardiologie II - Rhythmologie, Universitätsklinik Münster, Münster, Germany. 4. Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany. 5. Klinikum am Urban Berlin und im Friedrichshain, Berlin, Germany. 6. Universitätsmedizin Rostock, Rostock, Germany. 7. Praxisklinik Herz und Gefäße, Dresden, Germany. 8. Krankenhaus St. Elisabeth, Straubing, Germany. 9. Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany. 10. Klinikum Coburg, Coburg, Germany. 11. Klinikum Bielefeld, Bielefeld, Germany. 12. St. Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany. 13. Universitätsklinik München-Großhadern, Munich, Germany. 14. Klinikum Lüdenscheid, Luedenscheid, Germany.
Abstract
BACKGROUND: In patients with high risk for sudden cardiac death the implantation of a defibrillator is an established treatment. However the benefits and risks for patients in accordance to the number of the leads are not clear. Even in the current guidelines a recommendation to this question is missing. We analyzed advantage and disadvantages of single-chamber implantable cardioverter defibrillators (VVI-ICD) versus dual-chamber implantable cardioverter defibrillators (DDD-ICD) in the prospective German Device Registry. METHODS: The data of 2240 patients who underwent ICD implantation in 45 German Centers between January 2007 and March 2011 were included in a prospective device registry (VVI: n = 1629, male = 1358, EF = 34% ± 13%; DDD: n = 611, male = 491, EF = 35% ± 14%). RESULTS: The in-hospital complications were significantly higher in the DDD-ICD group with higher revision/device complication rates (3.0% vs. 1.2%; p = 0.003) but also higher mortality rate (1.0% vs. 0.1%; p < 0.001). Regarding the adjusted data at 1-year follow-up DDD-ICD caused more device revisions, but no difference in rehospitalization and mortality. CONCLUSION: It is still unclear whether DDD-ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function. Our data show that the decision of the operator to choose a DDD-ICD in these patients must be taken very carefully. By choosing a DDD-ICD the patient is exposed to a significantly higher periprocedural complication rate and higher in-hospital mortality. In absence of relevant bradycardias implantation of a DDD-ICD is not justified.
BACKGROUND: In patients with high risk for sudden cardiac death the implantation of a defibrillator is an established treatment. However the benefits and risks for patients in accordance to the number of the leads are not clear. Even in the current guidelines a recommendation to this question is missing. We analyzed advantage and disadvantages of single-chamber implantable cardioverter defibrillators (VVI-ICD) versus dual-chamber implantable cardioverter defibrillators (DDD-ICD) in the prospective German Device Registry. METHODS: The data of 2240 patients who underwent ICD implantation in 45 German Centers between January 2007 and March 2011 were included in a prospective device registry (VVI: n = 1629, male = 1358, EF = 34% ± 13%; DDD: n = 611, male = 491, EF = 35% ± 14%). RESULTS: The in-hospital complications were significantly higher in the DDD-ICD group with higher revision/device complication rates (3.0% vs. 1.2%; p = 0.003) but also higher mortality rate (1.0% vs. 0.1%; p < 0.001). Regarding the adjusted data at 1-year follow-up DDD-ICD caused more device revisions, but no difference in rehospitalization and mortality. CONCLUSION: It is still unclear whether DDD-ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function. Our data show that the decision of the operator to choose a DDD-ICD in these patients must be taken very carefully. By choosing a DDD-ICD the patient is exposed to a significantly higher periprocedural complication rate and higher in-hospital mortality. In absence of relevant bradycardias implantation of a DDD-ICD is not justified.