Temporal Trends in and FactorsAssociated With Use of Single-VersusDual-Coil Implantable Cardioverter-Defibrillator Leads: Data From the NCDR ICD Registry.

Abstract

This analysis evaluated temporal trends and factors associated with the use of dual-coil implantable cardioverter-defibrillator (ICD) leads. Data suggest that dual-coil ICD leads are not associated with lower mortality and can be more difficult to extract than single-coil leads. A total of 435,772 patients at 1,690 hospitals underwent ICD lead insertion in the National Cardiovascular Data Registry's ICD Registry between April 2010 and December 2015. Hospitals were classified into 3 pre-specified groups (low, decreasing, or high use) based on the frequency of dual-coil lead use. Nationally, the use of dual-coil leads has decreased over time, from 87% of ICD leads in early 2010 to 55% at the end of 2015. Hospitals in the low-use (n= 292) or decreasing-use (n= 561) group had more ICDs inserted by electrophysiologists compared to the high-use (n= 837) group (90% or 80% vs 46%; p< 0.001 for both) and more extractions performed (median 7 or 11 vs 2; p< 0.001 for both). Despite statistical differences, there were no clinically significant differences in patient characteristics across all 3 groups. Although the use of dual-coil ICD leads has decreased over time, it continues to represent the majority of insertions in the United States. Hospital-level factors, but not patient factors, were associated with use of dual-coil ICD leads. Whether decreasing dual-coil ICD lead use has improved patient outcomes remains unknown and should be examined in large, multicenter, contemporaneous patient groups.