Document Detail

No Benefit of a Dual Coil over a Single Coil ICD Lead: Evidence from the Sudden Cardiac Death in Heart Failure Trial.
MedLine Citation:
PMID:  23562699     Owner:  NLM     Status:  Publisher    
BACKGROUND: Dual coil ICD leads with a superior vena cava (SVC) electrode have been considered standard of care despite sparse data suggesting improved ICD defibrillation efficacy. SVC coils increase lead complexity, cost, risk of lead failure, and lead removal. The purpose of this study was to compare all-cause mortality, sudden cardiac death, implant defibrillation threshold test (DFT) energies, appropriate shock rates, and first shock efficacy for ventricular tachyarrhythmias, for dual coil vs. single coil leads in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). METHODS: In SCD-HeFT, 811 heart failure patients received a single lead transvenous ICD (Medtronic 7223) and underwent protocol driven DFT testing. Selection of a dual vs. single coil right ventricular (RV) lead was at the physician's discretion. DFT data were available in 717 patients. RESULTS: Dual coil leads were used in 563 and single coil in 246 patients. After 45.5 months follow-up, overall mortality was similar, 19.4% vs. 21.5% (dual vs. single), adjusted hazard ratio=0.95 (95% confidence intervals [CI], 0.68, 1.34) p=0.78. Sudden cardiac death was also similar (dual 3.6% vs. single 3.7%, p=0.96). First shock efficacy was 82.2% vs. 91.9% (dual vs. single), unadjusted odds ratio=0.41 (95% CI, 0.15, 1.13) p=0.085. Mean DFT was 12.1 + 4.7J vs. 12.8 + 4.8J (dual vs. single) p=0.087. CONCLUSIONS: In SCD-HeFT, the addition of an SVC coil for left-sided implants was not associated with improved outcome measures. We advocate returning to single coil RV ICD leads as the standard of care to decrease chronic lead complications.
Pierre S Aoukar; Jeanne E Poole; George W Johnson; Jill Anderson; Anne S Hellkamp; Daniel B Mark; Kerry L Lee; Gust H Bardy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-4
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Inc.
University of Washington, Seattle, WA.
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