Open AccessComparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators
Author(s) -
Peterson Pamela N.,
Greenlee Robert T.,
Go Alan S.,
Magid David J.,
CassidyBushrow Andrea,
GarciaMontilla Romel,
Glenn Karen A.,
Gurwitz Jerry H.,
Hammill Stephen C.,
Hayes John,
Kadish Alan,
Reynolds Kristi,
Sharma Param,
Smith David H.,
Varosy Paul D.,
Vidaillet Humberto,
Zeng Chan X.,
Normand SharonLise T.,
Masoudi Frederick A.
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006937
Subject(s) - medicine , hazard ratio , implantable cardioverter defibrillator , confidence interval , sudden cardiac death , heart failure , cardiology , propensity score matching
Background In US clinical practice, many patients who undergo placement of an implantable cardioverter‐defibrillator ( ICD ) for primary prevention of sudden cardiac death receive dual‐chamber devices. The superiority of dual‐chamber over single‐chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compare risk of adverse outcomes, including inappropriate shocks, between single‐ and dual‐chamber ICD s for primary prevention. Methods and Results We identified patients receiving a single‐ or dual‐chamber ICD for primary prevention who did not have an indication for pacing from 15 hospitals within 7 integrated health delivery systems in the Longitudinal Study of Implantable Cardioverter‐Defibrillators from 2006 to 2009. The primary outcome was time to first inappropriate shock. ICD shocks were adjudicated for appropriateness. Other outcomes included all‐cause hospitalization, heart failure hospitalization, and death. Patient, clinician, and hospital‐level factors were accounted for using propensity score weighting methods. Among 1042 patients without pacing indications, 54.0% (n=563) received a single‐chamber device and 46.0% (n=479) received a dual‐chamber device. In a propensity‐weighted analysis, device type was not significantly associated with inappropriate shock (hazard ratio, 0.91; 95% confidence interval, 0.59–1.38 [ P =0.65]), all‐cause hospitalization (hazard ratio, 1.03; 95% confidence interval, 0.87–1.21 [ P =0.76]), heart failure hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.72–1.21 [ P =0.59]), or death (hazard ratio, 1.19; 95% confidence interval, 0.93–1.53 [ P =0.17]). Conclusions Among patients who received an ICD for primary prevention without indications for pacing, dual‐chamber devices were not associated with lower risk of inappropriate shock or differences in hospitalization or death compared with single‐chamber devices. This study does not justify the use of dual‐chamber devices to minimize inappropriate shocks.