Related Experiment Video
Updated: Aug 14, 2026
Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources: A Computational Model
Published on: February 10, 2011
[How many leads are needed for an ICD?]
Anselm Schaumann1, Martin Gödde, Tobias Tönnis
1Abteilung Kardiologie, AK St. Georg, Hamburg, aschauman@aol.com
Insights
Implantable cardioverter defibrillators (ICDs) are increasingly used for primary prevention of sudden cardiac death (SCD) in patients with reduced left ventricular function. Device selection depends on individual patient factors like AV conduction and QRS duration.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Context:
- The use of implantable cardioverter defibrillators (ICDs) is expanding beyond secondary prevention to include primary prevention of sudden cardiac death (SCD).
- Key clinical trials like MADIT II, Companion, and SCD-HeFT support the use of ICDs for primary SCD prevention.
- Reduced left ventricular ejection fraction (LVEF ≤ 35%) is a primary risk factor for SCD.
Purpose:
- To outline the criteria for selecting appropriate implantable cardioverter defibrillator (ICD) devices and lead configurations for sudden cardiac death (SCD) prevention.
- To guide clinicians in choosing the optimal ICD therapy based on patient-specific clinical parameters.
Summary:
- For primary prevention of SCD, a single-lead VVI ICD is often sufficient, particularly when LVEF is reduced.
- Biventricular ICD devices are preferred for patients with AV conduction delay, symptomatic heart failure, and prolonged QRS duration, facilitating ventricular resynchronization.
- Dual-chamber devices are best reserved for sinus nodal disease and situations requiring enhanced discrimination of slow ventricular tachycardias.
Impact:
- Optimizing ICD selection can improve patient outcomes and reduce the incidence of sudden cardiac death.
- Tailoring device choice to individual patient profiles ensures effective therapy and appropriate resource utilization.
- This approach enhances the management of heart failure patients at risk for SCD.
Abstract:
In addition to secondary prevention of sudden cardiac death (SCD), the number of cardioverter defibrillator implantations (ICD) for primary prevention is increasing. An indication for primary prevention of SCD is supported by results of the MADIT II, Companion and SCD-HeFT trials. The main risk factor for SCD is the reduced left ventricular function (LVEF < or = 35%). For selecting the appropriate ICD device and the number of leads, several clinical parameters are important. For the primary prevention of SCD a single-lead VVI ICD is usually sufficient. In case of AV conduction delay and symptomatic heart failure with a prolonged QRS duration a biventricular ICD device is preferred in favor of a ventricular resynchronization. The use of a dual-chamber device should be limited to sinus nodal disease and better discrimination capabilities for slow ventricular tachycardias.
