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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-Figuero
  • 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
Article
  • 2 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

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

Notes

Acknowledgments

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.

References

  1. 1.
    Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the Europe. Eur Heart J. 2015;36(41):2793–867.  https://doi.org/10.1093/eurheartj/ehv316.CrossRefPubMedGoogle Scholar
  2. 2.
    Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359(10):1009–17.  https://doi.org/10.1056/NEJMoa071098.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm. 2010;7(3):353–60.  https://doi.org/10.1016/j.hrthm.2009.11.027.CrossRefPubMedGoogle Scholar
  4. 4.
    Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, et al. Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation. 2002;105(5):589–94.CrossRefPubMedGoogle Scholar
  5. 5.
    Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367(24):2275–83.  https://doi.org/10.1056/NEJMoa1211107.CrossRefPubMedGoogle Scholar
  6. 6.
    Fischer A, Ousdigian KT, Johnson JW, Gillberg JM, Wilkoff BL. The impact of atrial fibrillation with rapid ventricular rates and device programming on shocks in 106,513 ICD and CRT-D patients. Heart Rhythm. 2012;9(1):24–31.  https://doi.org/10.1016/j.hrthm.2011.08.005.CrossRefPubMedGoogle Scholar
  7. 7.
    Theuns DAMJ, Klootwijk APJ, Goedhart DM, Jordaens LJLM. Prevention of inappropriate therapy in implantable cardioverter-defibrillators: results of a prospective, randomized study of tachyarrhythmia detection algorithms. J Am Coll Cardiol. 2004;44(12):2362–7.  https://doi.org/10.1016/j.jacc.2004.09.039.CrossRefPubMedGoogle Scholar
  8. 8.
    Friedman PA, McClelland RL, Bamlet WR, Acosta H, Kessler D, Munger TM, et al. Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: the detect supraventricular tachycardia study. Circulation. 2006;113(25):2871–9.  https://doi.org/10.1161/CIRCULATIONAHA.105.594531.CrossRefPubMedGoogle Scholar
  9. 9.
    Gold MR, Ahmad S, Browne K, Berg KC, Thackeray L, Berger RD. Prospective comparison of discrimination algorithms to prevent inappropriate ICD therapy: primary results of the Rhythm ID Going Head to Head Trial. Heart Rhythm. 2012;9(3):370–7.  https://doi.org/10.1016/j.hrthm.2011.10.004.CrossRefPubMedGoogle Scholar
  10. 10.
    Olshansky B, Day JD, Moore S, Gering L, Rosenbaum M, McGuire M, et al. Is dual-chamber programming inferior to single-chamber programming in an implantable cardioverter-defibrillator? Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AVSH in ICDs) study. Circulation. 2007;115(1):9–16.  https://doi.org/10.1161/CIRCULATIONAHA.106.629428.CrossRefPubMedGoogle Scholar
  11. 11.
    Almendral J, Arribas F, Wolpert C, Ricci R, Adragao P, Cobo E, et al. Dual-chamber defibrillators reduce clinically significant adverse events compared with single-chamber devices: results from the DATAS (Dual chamber and Atrial Tachyarrhythmias Adverse events Study) trial. Europace. 2008;10(5):528–35.  https://doi.org/10.1093/europace/eun072.CrossRefPubMedGoogle Scholar
  12. 12.
    Friedman PA, Bradley D, Koestler C, Slusser J, Hodge D, Bailey K, et al. A prospective randomized trial of single- or dual-chamber implantable cardioverter-defibrillators to minimize inappropriate shock risk in primary sudden cardiac death prevention. Europace. 2014;16(10):1460–8.  https://doi.org/10.1093/europace/euu022.CrossRefPubMedGoogle Scholar
  13. 13.
    Kolb C, Sturmer M, Sick P, Reif S, Davy JM, Molon G, et al. Reduced risk for inappropriate implantable cardioverter-defibrillator shocks with dual-chamber therapy compared with single-chamber therapy: results of the randomized OPTION study. JACC Heart Fail. 2014;2(6):611–9.  https://doi.org/10.1016/j.jchf.2014.05.015.CrossRefPubMedGoogle Scholar
  14. 14.
    van Rees JB, Borleffs CJW, de Bie MK, Stijnen T, van Erven L, Bax JJ, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57(5):556–62.  https://doi.org/10.1016/j.jacc.2010.06.059.CrossRefPubMedGoogle Scholar
  15. 15.
    Peterson PN, Greenlee RT, Go AS, Magid DJ, Cassidy-Bushrow A, Garcia-Montilla R, Masoudi FA. Comparison of inappropriate shocks and other health outcomes between single- and dual-chamber implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: results from the cardiovascular research network longitudinal study of I. J Am Heart Assoc 2017;6(11). doi: https://doi.org/10.1161/JAHA.117.006937.
  16. 16.
    Konstantino Y, Haim M, Boxer J, Goldenberg I, Feldman A, Michowitz Y, et al. Clinical outcomes of single- versus dual-chamber implantable cardioverter defibrillators: lessons from the Israeli ICD Registry. J Cardiovasc Electrophysiol. 2016;27(6):718–23.  https://doi.org/10.1111/jce.12953.CrossRefPubMedGoogle Scholar
  17. 17.
    Ruwald A-CH, Sood N, Ruwald MH, Jons C, Clyne CA, McNitt S, et al. Frequency of inappropriate therapy in patients implanted with dual- versus single-chamber ICD devices in the ICD arm of MADIT-CRT. J Cardiovasc Electrophysiol. 2013;24(6):672–9.  https://doi.org/10.1111/jce.12099.CrossRefPubMedGoogle Scholar
  18. 18.
    Weeke P, Johansen JB, Jorgensen OD, Nielsen JC, Moller M, Videbaek R, et al. Mortality and appropriate and inappropriate therapy in patients with ischaemic heart disease and implanted cardioverter-defibrillators for primary prevention: data from the Danish ICD Register. Europace. 2013;15(8):1150–7.  https://doi.org/10.1093/europace/eut017.CrossRefGoogle Scholar
  19. 19.
    Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm. 2016;13(2):e50–86.  https://doi.org/10.1016/j.hrthm.2015.11.018.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288(24):3115–23.CrossRefPubMedGoogle Scholar
  21. 21.
    Kuhlkamp V, Dornberger V, Mewis C, Suchalla R, Bosch RF, Seipel L. Clinical experience with the new detection algorithms for atrial fibrillation of a defibrillator with dual chamber sensing and pacing. J Cardiovasc Electrophysiol. 1999;10(7):905–15.CrossRefPubMedGoogle Scholar
  22. 22.
    Deisenhofer I, Kolb C, Ndrepepa G, Schreieck J, Karch M, Schmieder S, et al. Do current dual chamber cardioverter defibrillators have advantages over conventional single chamber cardioverter defibrillators in reducing inappropriate therapies? A randomized, prospective study. J Cardiovasc Electrophysiol. 2001;12(2):134–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Gasparini M, Proclemer A, Klersy C, Kloppe A, Lunati M, Ferrer JBM, et al. Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA. 2013;309(18):1903–11.  https://doi.org/10.1001/jama.2013.4598.CrossRefPubMedGoogle Scholar
  24. 24.
    Wilkoff BL, Kuhlkamp V, Volosin K, Ellenbogen K, Waldecker B, Kacet S, et al. Critical analysis of dual-chamber implantable cardioverter-defibrillator arrhythmia detection: results and technical considerations. Circulation. 2001;103(3):381–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Kuhlkamp V, Wilkoff BL, Brown AB, Volosin KJ, Hugl BJ, Stafford W, et al. Experience with a dual chamber implantable defibrillator. Pacing Clin Electrophysiol. 2002;25(7):1041–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Dijkman B, Wellens HJ. Dual chamber arrhythmia detection in the implantable cardioverter defibrillator. J Cardiovasc Electrophysiol. 2000;11(10):1105–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Auricchio A, Schloss EJ, Kurita T, Meijer A, Gerritse B, Zweibel S, et al. Low inappropriate shock rates in patients with single- and dual/triple-chamber implantable cardioverter-defibrillators using a novel suite of detection algorithms: PainFree SST trial primary results. Heart Rhythm. 2015;12(5):926–36.  https://doi.org/10.1016/j.hrthm.2015.01.017.CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Sem Briongos-Figuero
    • 1
  • 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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