Single-brand dual-chamber discriminators to prevent inappropriate shocks in patients implanted with prophylactic implantable cardioverter defibrillators: a propensity-weighted comparison of single- and dual-chamber devices

  • Sem Briongos-FigueroEmail author
  • Ana Sánchez
  • M. Luisa Pérez
  • José B. Martínez-Ferrer
  • Enrique García
  • Xavier Viñolas
  • Ángel Arenal
  • Javier Alzueta
  • Nuria Basterra
  • Aníbal Rodríguez
  • Ignacio Lozano
  • Roberto Muñoz-Aguilera



Comparisons of the efficacy of dual- vs. single-chamber implantable cardioverter defibrillators (ICDs) in preventing inappropriate shocks have had contradictory results. We investigated whether dual-chamber devices have a lower risk of inappropriate shocks and the specific role of supraventricular tachycardia (SVT) discriminators.


All heart failure (HF) patients without an indication for pacing and implanted with a prophylactic ICD were recruited from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.


Among 782 patients, single-chamber ICDs were implanted in 537 (68.7%) and dual-chamber devices in 245 (31.3%). During a mean follow-up of 52.2 ± 24.5 months, 109 inappropriate shocks were delivered in 49 patients (6.2%). In the propensity-score-matched analysis, dual-chamber ICDs were related to lower rates of inappropriate shocks as compared to single-chamber devices (0.9% vs. 11.8%, p = < 0.001, log-rank test). In multivariable Cox proportional analysis, independent predictors of inappropriate shock were history of atrial fibrillation (hazard ratio (HR) = 2.78, CI 1.37–5.64, p = 0.004), chronic kidney disease (HR = 6.15, CI 2.82–13.53, p < 0.001), and non-ischemic cardiomyopathy (HR = 2.84, CI 1.54–5.23, p = 0.001). Among ICD settings, PR logic was the only discriminator independently related to a reduced risk of inappropriate shocks (HR = 0.18, CI 0.06–0.48, p = 0.001), along with an SVT limit enabled over 200 bpm (HR = 0.24, CI 0.11–0.51, p < 0.001).


In this nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were related to lower risk of inappropriate shocks compared to single-chamber ICDs. Besides, PR logic and SVT limit > 200 bpm emerged as protective factors.


Inappropriate shock Dual-chamber Implantable cardioverter defibrillator PR logic Atrial fibrillation 



The authors acknowledge the Spanish Scoop team, especially Alba García, Esther Sastre, and Cristina Álvarez.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sem Briongos-Figuero
    • 1
    Email author
  • Ana Sánchez
    • 1
  • M. Luisa Pérez
    • 2
  • José B. Martínez-Ferrer
    • 3
  • Enrique García
    • 4
  • Xavier Viñolas
    • 5
  • Ángel Arenal
    • 6
  • Javier Alzueta
    • 7
  • Nuria Basterra
    • 8
  • Aníbal Rodríguez
    • 9
  • Ignacio Lozano
    • 10
  • Roberto Muñoz-Aguilera
    • 1
  1. 1.Cardiology DepartmentHospital Universitario Infanta LeonorMadridSpain
  2. 2.Complejo Hospitalario Universitario A CoruñaA CoruñaSpain
  3. 3.Hospital Universitario de ÁrabaVitoria-GasteizSpain
  4. 4.Complejo Hospitalario Universitario de VigoVigoSpain
  5. 5.Hospital Santa Creu i Sant PauBarcelonaSpain
  6. 6.Hospital Universitario Gregorio MarañónMadridSpain
  7. 7.Hospital Virgen de la VictoriaMálagaSpain
  8. 8.Complejo Hospitalario de NavarraPamplonaSpain
  9. 9.Hospital Universitario de CanariasSanta Cruz de TenerifeSpain
  10. 10.Hospital Universitario Puerta de HierroMadridSpain

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