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How To Choose Between Single-Chamber and Dual-Chamber ICD

  • Maurizio Del Greco
  • Lorena Gramegna
  • Massimiliano Marini
  • Marcello Disertori
Conference paper

Abstract

Patients in whom an implantable cardioverter defibrillator (ICD) is indicated and who have concomitant significant sinus-node disease or atrioventricular block may be candidates for a dual-chamber device. However, it is still a matter of debate whether the dual-chamber ICD is also advantageous for patients with preserved sinus and atrioventricular nodal function, as data from prospective randomized trials are limited. Overall, the number of implanted dual-chamber devices has been increasing and, according to the 2003 AIAC Registry data, accounted for one-third of all the defibrillators implanted in Italy, while single chamber devices made up 39%. The theoretical advantages of dual-chamber ICDs are: better supraventricular tachycardia (SVT) discrimination, optimal treatment of bradyarrhythmias (pre-existing or drug induced), and major hemodynamic benefits.

Keywords

Implantable Cardioverter Defibrillator Ventricular Pace Implantable Defibrillator Dual Chamber Dual Chamber Pacemaker 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Barold HS, Newby KH, Tomassoni G et al (1998) Prospective evaluation of new and old criteria to discriminate between supraventricular and ventricular tachycardia in implantable defibrillators. Pacing Clin Electrophysiol 21:1347–1355PubMedCrossRefGoogle Scholar
  2. 2.
    Swerdlow CD, Chen PS, Kass RM et al (1994) Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter defibrillator. J Am Coll Cardiol 23:1342–1355PubMedCrossRefGoogle Scholar
  3. 3.
    Neuzner J, Pitschner HF, Schlepper (1995) Programmable VT detection enhancements in implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol 18:539–547PubMedCrossRefGoogle Scholar
  4. 4.
    Sadoul N, Jung W, Jordaens L et al (2002) Diagnostic performance of a dual-chamber cardioverter defibrillator programmed with nominal settings: a European prospective study. J Cardiovasc Electrophysiol 13:25–32PubMedCrossRefGoogle Scholar
  5. 5.
    Wilkoff BL, Kuhlkamp V, Volosin K et al (2001) Critical analysis of dual chamber implantable cardioverter defibrillator arrhythmia detection. Results and technical considerations. Circulation 103:381–386PubMedGoogle Scholar
  6. 6.
    Korte T, Jung W, Wolpert C et al (1998) A new classification algorithm for discrimination of ventricular from supraventricular tachycardia in a dual chamber implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 9:70–73PubMedCrossRefGoogle Scholar
  7. 7.
    Hintringer F, Schwarzacher S, Eibl G, Pachinger O (2001) Inappropriate detection of supraventricular arrhythmias by implantable dual chamber defibrillators: a comparison of four different algorithms. Pacing Clin Electrophysiol 24:835–841PubMedCrossRefGoogle Scholar
  8. 8.
    Deisenhofer I, Kolb C, Ndrepepa G et al (2001 Do current dual chamber cardioverter defibrillators have advantages over conventional single chamber cardioverter defibrillator in reducing inappropriate therapies? A randomized, prospective study. J Cardiovasc Electrophysiol 12:134–142PubMedCrossRefGoogle Scholar
  9. 9.
    Friedman PA, McClelland RL, Bamlet WR et al (2006) Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: the detect supraventricular tachycardia study. Circulation 113:2871–289PubMedCrossRefGoogle Scholar
  10. 10.
    Hesselson AB, Parsonnet V, Bernstein AD, Bonavita GJ (1992) Deleterious effect of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol 19:1542–1549PubMedCrossRefGoogle Scholar
  11. 11.
    Frielingsdorf J, Deseo T, Gerber AE, Bertel O (1996) A comparison of quality-of-life in patients with dual chamber pacemakers and individually programmed atrioventricular delays. Pacing Clin Electrophysiol 19:1147–1154PubMedCrossRefGoogle Scholar
  12. 12.
    Harper GR, Pina IL, Kutalek SP (1991) Intrinsic conduction maximizes cardiopulmonary performance in patients with dual chamber pacemakers. Pacing Clin Electrophysiol 14:1787–1791PubMedCrossRefGoogle Scholar
  13. 13.
    Wilkoff BL, Cook JR, Epstein AE et al (2002) The DAVID Trial Investigators: dual chamber pacing or ventricular backup pacing in patients with an implantable defibrillator. The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 288:3115–3123PubMedCrossRefGoogle Scholar
  14. 14.
    Kolb C, Deisenhofer I, Schmieder S et al (2006) Long-term follow-up of patients supplied with single-chamber or dual-chamber cardioverter defibrillators. Pacing Clin Electrophysiol 29:946–952PubMedCrossRefGoogle Scholar
  15. 15.
    Sukhija R, Aronow WS, Sorbera C et al (2005) Left ventricular ejection fraction and prevalence of new left ventricular wall motion abnormality at long-term follow-up in patients with automatic implantable cardioverter-defibrillators treated with dual-chamber rate-responsive pacing at a rate of 70/minute versus backup ventricular pacing at a rate of 40/minute. Am J Cardiol 96:412–413PubMedCrossRefGoogle Scholar
  16. 16.
    Sweeney MO, Ellenbogen KA, Miller EH et al (2006) The Managed Ventricular pacing versus VVI 40 Pacing (MVP) Trial: clinical background, rationale, design, and implementation. J Cardiovasc Electrophysiol 17:1295–1298PubMedCrossRefGoogle Scholar
  17. 17.
    Schmitt C, Montero M, Melichercik J (1998) Significance of supraventricular tachyarrhythmias in patients with implanted pacing cardioverter defibrillators. Pacing Clin Electrophysiol 17:295–302CrossRefGoogle Scholar
  18. 18.
    Grimm W, Flores BF, Marchlinski FE (1992) Electrocardiographically documented unnecessary, spontaneous shocks in 241 patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 15:1667–1673PubMedCrossRefGoogle Scholar
  19. 19.
    Marchlinski FE, Callans DJ, Gottlieb CD et al (1995) Benefits and lessons learned from stored electrogram information in implantable defibrillators. J Cardiovasc Electrophysiol 6:832–851PubMedCrossRefGoogle Scholar
  20. 20.
    Pinski SL, Yao Q, Epstein AE et al (2000 Determinants of outcome in patients with sustained ventricular tachyarrhythmias: the antiarrhythmic versus implantable defibrillators (AVID) study registry. Am Heart J 139:804–813PubMedCrossRefGoogle Scholar
  21. 21.
    Wolf PA, Mitchell JB, Baker CS et al (1998) Impact of atrial fibrillation on mortality, stroke and medical costs. Arch Intern Med 158:229–234PubMedCrossRefGoogle Scholar
  22. 22.
    Ricci R, Pignalberi C, Disertori M et al (2002) Efficacy of a dual chamber defibrillator with atrial antitachycardia functions in treating spontaneous atrial tachyarrhythmias in patients with life-threatening ventricular tachyarrhythmias. Eur Heart J 23:1471–1479PubMedCrossRefGoogle Scholar
  23. 23.
    Friedman PA, Dijkman B, Warman EN et al for the Worldwide Jewel AF Investigators (2001) Atrial therapies reduce atrial arrhythmia burden in defibrillator patients. Circulation 104:1023–1028PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Maurizio Del Greco
    • 1
  • Lorena Gramegna
    • 1
  • Massimiliano Marini
    • 1
  • Marcello Disertori
    • 1
  1. 1.Electrophysiology Laboratory, Cardiology DepartmentS. Chiara HospitalTrentoItaly

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