Clinical Impact, Safety, and Efficacy of Single- versus Dual-Coil ICD Leads in MADIT-CRT

Abstract

Current data on efficacy, safety and impact on clinical outcome of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads are limited and contradictory. Defibrillation threshold (DFT) at implantation and first shock efficacy were compared in patients implanted with single- versus dual-coil ICD leads in MADIT-CRT. The risk for atrial tachyarrhythmias and all-cause mortality were evaluated. Short- (< 30 days after the implantation) and long-term (throughout the entire study duration) complications were assessed. Patients with dual-coil ICD leads had significantly lower DFTs compared to patients with single-coil ICD leads (17.6 ± 5.8 J vs 19.4 ± 6.1 J, P < 0.001). First shock efficacy was similar among patients with dual and single-coil ICD leads (89.6% vs 92.3%, P= 1.00). When comparing patients with dual versus single-coil ICD leads, there was no difference in the risk of atrial tachyarrhythmias (HR= 1.57, 95% CI: 0.81-3.02, P= 0.18), or in the risk of all-cause mortality (HR= 1.10, 95% CI: 0.58-2.07, P= 0.77). Patients implanted with single- or dual-coil ICD lead had similar short and long-term complication rates (short-term HR= 0.96, 95% CI: 0.56-1.65, P= 0.88, long-term procedure-related HR= 0.99, 95% CI: 0.62-1.59, P= 1.00, long-term ICD lead related: HR= 1.2, 95% CI: 0.5-2.9, P= 0.68) during the mean follow-up of 3.3 years. Patients with single-coil ICD leads have slightly higher DFTs compared to those with dual-coil leads, but the efficacy, safety, and clinical impact on atrial tachyarrhythmias, and mortality is similar. Implantation of single-coil ICD leads may be favorable in most patients.