Dual-chamber ICDs: How Effective and Safe Are They in the Treatment of Atrial Tachyarrhythmias?

  • J. Kautzner
  • P. Peichl
Conference paper


The rapid development of internal cardioverter defibrillator (ICD) technology in the late 1990s resulted in the construction of sophisticated dual-chamber devices. Initially, the rationale behind their introduction was the possibility of sequential pacing for bradyarrhythmia whenever required, thus avoiding the need for parallel pacemaker implantation. At the same time, the use of an atrial lead was viewed as an opportunity to improve discrimination between supraventricular and ventricular arrhythmias. The experience obtained with atrial defibrillators and in studies on pacing prevention of atrial fibrillation was subsequently also exploited in novel ICD devices. Now, as they have such a powerful tool available, some clinicians suggest the use of dual-chamber devices in all ICD candidates who are in sinus rhythm [1]. Indeed, most ICDs currently implanted in the USA are dual-chamber devices [2]. On the other hand, there is mounting evidence that such an approach is not devoid of risk. Therefore, the purpose of this review is to discuss the pros and cons of dual-chamber ICDs.


Atrial Fibrillation Cardiac Resynchronization Therapy Atrial Tachycardia Biventricular Pace Sick Sinus Syndrome 
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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  1. 1.
    Santini M, Ricci R (2001) Atrial fibrillation coexisting with ventricular tachycardia: a challenge for dual chamber defibrillators. Heart 86:253–254PubMedGoogle Scholar
  2. 2.
    Product market mix of dual-chamber and single-chamber ICDs. Available at
  3. 3.
    Schmitt C, Montero M, Melichercik J (1998) Significance of supraventricular tachyarrhythmias in patients with implanted pacing cardioverter defibrillators 17:295–302Google Scholar
  4. 4.
    Best PJ, Hayes DL, Stanton MS (1999) The potential usage of dual chamber pacing in patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 22:79–85PubMedCrossRefGoogle Scholar
  5. 5.
    Schoels W, Swerdlow CD, Jung W et al (2001) Worldwide clinical experience with a new dual-chamber implantable cardioverter-defibrillator system. J Cardiovasc Electrophysiol 12:521–528PubMedCrossRefGoogle Scholar
  6. 6.
    Adler SW, Wolpert C, Warman EN et al (2001) Efficacy of pacing therapies for treating atrial tachyarrhythmias in patients with ventricular arrhythmias receiving a dual-chamber implantable cardioverter-defibrillator. Circulation 104:887–892PubMedCrossRefGoogle Scholar
  7. 7.
    Ricci R, Pignalberi C, Disertori M et al (2002) Efficacy of a dual chamber defibrillator with atrial antitachycardia functions in treating spontaneous atrial tachyarrhytmias in patients with life-threatening ventricular tachyarrhytmias. Eur Heart J 23:1471–1479PubMedCrossRefGoogle Scholar
  8. 8.
    Friedman PA, Dijkman B, Warman EN et al (2001) Atrial therapies reduce atrial arrhythmia burden in defibrillator patients. Circulation 104:1023–1028PubMedCrossRefGoogle Scholar
  9. 9.
    Prakash A (2002) Pacing for the prevention of atrial fibrillation. Curr Opin Cardiol 17:73–81PubMedCrossRefGoogle Scholar
  10. 10.
    Pinski SL, Fahy GJ (1995) The proarrhythmic potential of implantable cardioverter-defibrillators. Circulation 92:1651–1664PubMedCrossRefGoogle Scholar
  11. 11.
    Weber M, Block M, Brunn J et al (1996) Inadequate therapies with implantable car-dioverter-defibrillators-incidence, etiology, predictive factors and prevention strategies. Z Kardiol 85:809–819PubMedGoogle Scholar
  12. 12.
    Lüderitz B, Jung W, Deister A et al (1993) Patient acceptance of implantable cardio-verter-defibrillator in ventricular tachyarrhythmias. Pacing Clin Electrophysiol 16:1815–1821PubMedCrossRefGoogle Scholar
  13. 13.
    Birgetsdotter-Green U, Rosenqvist M, Lindemans FW et al (1992) Holter documented sudden death in a patient with an implanted defibrillator. Pacing Clin Electrophysiol 15:1008–1014CrossRefGoogle Scholar
  14. 14.
    Lavergne T, Daubert JC, Chauvin M et al (1997) Preliminary clinical experience with the first dual chamber pacemaker defibrillator. Pacing Clin Electrophysiol 20:182–188PubMedCrossRefGoogle Scholar
  15. 15.
    Trappe HJ, Achtelik M, Pfitzner P et al (1999) Single-chamber versus dual-chamber implantable cardioverter-defibrillators: indications and clinical results. Am J Cardiol 83(5B):8D–16DPubMedCrossRefGoogle Scholar
  16. 16.
    Kühlkamp V, Dornberger V, Mewis C et al (1999) Clinical experience with the new detection algorithms for atrial fibrillation of a defibrillator with dual chamber sensing and pacing. J Cardiovasc Electrophysiol 10:905–915PubMedCrossRefGoogle Scholar
  17. 17.
    Deisenhofer I, Kolb C, Ndrepepa G et al (1999) Do current dual chamber cardioverter defibrillators have advantages over conventional single chamber cardioverter defi-brillators in reducing inappropriate therapies: a randomized, prospective study. J Cardiovasc Electrophysiol 12:134–142bCrossRefGoogle Scholar
  18. 18.
    Andresen HR, Nielsen JC, Thomsen PE et al (1997) Long-term follow-up of patients from a randomized trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 350:1210–1216CrossRefGoogle Scholar
  19. 19.
    Lamas GA, Orav EJ, Stambler BS et al (1998) Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual chamber pacing. Pacemaker Selection in the Elderly Investigators. N Engl J Med 338:1097–1104PubMedCrossRefGoogle Scholar
  20. 20.
    Sweeney M, Hellkamp A, Greenspon A et al (2002) Baseline QRS duration ≥ 120 milliseconds and cumulative percent time ventricular paced predicts increased risk of heart failure, stroke, and death in DDDR/paced patients with sick sinus syndrome in MOST (abstract). Pacing Clin Electrophysiol 25:690CrossRefGoogle Scholar
  21. 21.
    Moss AJ, Zareba W, Hall WJ et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883PubMedCrossRefGoogle Scholar
  22. 22.
    The DAVID Trial Investigators (2002) Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 288:3115–3123CrossRefGoogle Scholar
  23. 23.
    Takahashi T, Bhandari A, Watanuki M et al (2002) High incidence of device-related and lead-related complications in the dual-chamber implantable cardioverter defibrillator compared with the single-chamber version. Circ J 66:748–750Google Scholar
  24. 24.
    Bristow MR, Saxon LA, Boehmer J et al Cardiac resynchronization therapy (CRT) reduces hospitalizations, and CRT+an implantable defibrillator (CRT-D) reduces mortality in chronic heart failure: preliminary results of the COMPANION Trial.
  25. 25.
    Proclemer A, Della Bella P, Facchin D et al (2001) Indications for dual-chamber car-dioverter defibrillators at implant and at 1 year follow-up: a retrospective analysis in the single-chamber defibrillator era. Europace 3:132–135PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • J. Kautzner
    • 1
  • P. Peichl
    • 1
  1. 1.Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic

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