Single-coil and dual-coil defibrillator leads and association with clinical outcomes in a complete Danish nationwide ICD cohort

Jacob M Larsen, Søren P Hjortshøj, Jens C Nielsen, Jens B Johansen, Helen H Petersen, Jens Haarbo, Martin B Johansen, Anna Margrethe Thøgersen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: The best choice of defibrillator lead in patients with routine implantable cardioverter-defibrillator (ICD) is not settled. Traditionally, most physicians prefer dual-coil leads but the use of single-coil leads is increasing.

OBJECTIVE: The purpose of this study was to compare clinical outcomes in patients with single- and dual-coil leads.

METHODS: All 4769 Danish patients 18 years or older with first-time ICD implants from 2007 to 2011 were included from the Danish Pacemaker and ICD Register. Defibrillator leads were 38.9% single-coil leads and 61.1% dual-coil leads. The primary end point was all-cause mortality. Secondary end points were lowest successful energy at implant defibrillation testing, first shock failure in spontaneous arrhythmias, structural lead failure, and lead extraction outcomes.

RESULTS: Single-coil leads were associated with lower all-cause mortality with an adjusted hazard ratio of 0.85 (95% confidence interval 0.73-0.99; P = .04). This finding was robust in a supplementary propensity score-matched analysis. However, dual-coil leads were used in patients with slightly higher preimplant morbidity, making residual confounding by indication the most likely explanation for the observed association between lead type and mortality. The lowest successful defibrillation energy was higher using single-coil leads (23.2 ± 4.3 J vs 22.1 ± 3.9 J; P < .001). No significant differences were observed for other secondary end points showing high shock efficacies and low rates of lead failures and extraction complications.

CONCLUSION: Shock efficacy is high for modern ICD systems. The choice between single-coil and dual-coil defibrillator leads is unlikely to have a clinically significant impact on patient outcomes in routine ICD implants.

Original languageEnglish
JournalHeart Rhythm
Volume13
Issue number3
Pages (from-to)706–712
ISSN1547-5271
DOIs
Publication statusPublished - Mar 2016

Keywords

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Mortality
  • Leads
  • ICD
  • Lead extraction
  • Defibrillation
  • Implantable cardioverter-defibrillator
  • Lead failure
  • Coil

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