Premium
Long‐Term Follow‐Up of Patients Supplied with Single‐Chamber or Dual‐Chamber Cardioverter Defibrillators
Author(s) -
KOLB CHRISTOF,
DEISENHOFER ISABEL,
SCHMIEDER SEBASTIAN,
BARTHEL PETRA,
ZRENNER BERNHARD,
KARCH MARTIN R.,
SCHMITT CLAUS
Publication year - 2006
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2006.00467.x
Subject(s) - medicine , cardiology , single chamber , confidence interval , implantable cardioverter defibrillator
In patients who have an indication for an implantable cardioverter defibrillator (ICD) a dual‐chamber device is indicated in the case of concomitant significant sinus node disease or atrioventricular block. It is a matter of debate whether dual‐chamber ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function as data from prospective randomized trials are limited. Mid‐ or long‐term follow‐up data are unavailable.Methods and Results: One hundred patients (age 60 ± 12 years, 11 women) with the indication for the implantation of an ICD and without antibradycardia pacing indication were randomly assigned to either receive a dual‐chamber ICD (n = 52) or a single‐chamber ICD (n = 48). Patients were followed‐up for a mean of 52 ± 14 months. Mortality and arrhythmogenic morbidity were assessed.All‐cause mortality was 21% for single‐chamber and 31% for dual‐chamber ICD recipients, respectively (P = 0.26). Cardiovascular mortality was 13% for single‐chamber ICD recipients versus 21% in the dual‐chamber group (P = 0.25). Subgroup analysis using 35% of ventricular paced beats as cutoff value in the dual‐chamber ICD group revealed a 42% mortality rate for the patients with frequent ventricular pacing compared to 10% of patients with a low rate of ventricular pacing (P = 0.05, relative risk 4.21, 95% confidence interval: 0.9–19.8). As for arrhythmogenic morbidity, the difference in the ventricular tachyarrhythmia load was not different in both groups (single chamber: 23 ± 74 VT episodes, dual chamber: 54 ± 134 VT episodes, P = 0.17).Conclusion: In ICD recipients without conventional indication for dual‐chamber pacing, dual chamber compared to single‐chamber ICD has no advantage concerning mortality and arrhythmogenic morbidity in a long‐term follow‐up. In these patients the implantation of a single‐chamber device is sufficient.