Abstract P75: Discretionary Use of Dual Lead Implantable Cardioverter-Defibrillators (ICDs) by Hospital

Abstract

Introduction: Current evidence does not support the use of dual lead ICDs over single lead ICDs for the primary prevention of sudden cardiac death in patients without a permanent pacing indication. The objective of this analysis was to explore hospital-level variation in the use of “discretionary” dual lead ICDs in a population without a clear indication for a permanent pacemaker. Methods: Using data from the National Cardiovascular Data Registry, we determined the total number of primary prevention ICDs implanted in each hospital where the choice between single and dual lead would be discretionary by excluding patients with a guideline-based indication for a permanent pacemaker (QRS > 120 msec, sinus node dysfunction, or 2 nd or 3 rd degree heart block). Using hierarchical logistic regression adjusted for clustering within hospitals, we then determined patient, physician, and hospital level correlates of receiving a dual lead ICD. Results: Marked hospital level variation exists in the use of “discretionary” dual lead devices, ranging from 0% to 100% (figure). Patients were more likely to receive a dual lead ICD if they had atrial fib/flutter (OR 1.41) or if their ICD was implanted by a surgeon (OR 2.22). Black patients (OR 0.90), patients on dialysis (OR 0.86), and patients at academic medical centers (OR 0.61) were less likely to receive a dual lead ICD. Conclusions: Use of dual lead ICDs among patients without indications for permanent pacing varies markedly at the hospital level. Given the paucity of data supporting dual lead ICDs in this population, research is needed to understand why this variation exists as well as on the comparative effectiveness of single and dual lead ICDs.