The first year experience with the dual chamber ICD

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• The dual chamber implantable cardioverter defibrillator (ICD) with tiered therapy was introduced in the US in July 1997.
• This study reviews the initial year of experience with this new dual chamber ICD at a single US center.

Purpose of the Study:

• To evaluate the early clinical experience with dual chamber ICDs, including implantation times, indications, and complication rates.
• To assess the adoption and learning curve associated with the dual chamber ICD in a clinical setting.

Main Methods:

• Retrospective analysis of 174 implantable cardioverter defibrillator (ICD) procedures performed over one year.
• Data collected included device type (single vs. dual chamber), implantation duration, patient indications, and complications.
• Procedure times were analyzed for new implants and upgrades, with a focus on identifying a learning curve.

Main Results:

• Dual chamber ICDs constituted 55% (95/174) of new implants within the first year.
• Initial implantation times for dual chamber ICDs averaged 57.4 minutes, decreasing to 45.1 minutes with experience, indicating a learning curve.
• Complications were infrequent (2.8%), with a notable 8.8% rate of late infection requiring explantation in dual chamber upgrade patients.

Conclusions:

• The dual chamber ICD rapidly gained significant adoption, becoming the majority of new implants at the center within its first year.
• A learning curve was observed, leading to reduced procedure times as experience with the dual chamber ICD increased.
• While overall complications were low, careful consideration for dual chamber upgrades is warranted due to potential late infection risks.