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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
The implantable cardioverter defibrillator in primary prevention: a revision of monocentric study group
L Gigli1, D Barabino, P Sartori
1aElectrophysiology, Department of General Internal Medicine, IRCCS San Martino University Hospital - IST National Institute for Cancer Research bMedi Service Management Unit World Trade Center cPrimary Hospital, Department of General Internal Medicine, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy *D. Barabino deceased.
Insights
Dual-chamber implantable cardioverter defibrillators (ICDs) significantly reduced mortality in primary prevention patients compared to single-chamber devices. Patients with coronary artery disease and low ejection fraction faced higher mortality risks.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Implantable cardioverter defibrillators (ICDs) are used for primary prevention of sudden cardiac death.
- Comparing single-chamber vs. dual-chamber ICD performance is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate mortality, morbidity, and intervention rates in patients receiving ICDs for primary prevention.
- To compare the effectiveness of single-chamber versus dual-chamber ICDs.
Main Methods:
- Retrospective analysis of 193 patients with coronary artery disease (CAD) or cardiomyopathy (CMD) receiving ICDs for primary prevention.
- Evaluation of survival, implantation complications, and device performance (antitachycardia pacing/shock) over a mean follow-up of 49.9 months.
Main Results:
- Dual-chamber ICDs showed significantly lower overall mortality (17%) compared to single-chamber ICDs (32.4%).
- Higher mortality was observed in patients with CAD (33.9%).
- Patients with ejection fraction ≤25% had a higher mortality rate (69% of fatalities).
Conclusions:
- The 4-year survival rate was 72%.
- Dual-chamber ICDs are associated with significantly lower mortality rates.
- Ejection fraction and underlying coronary artery disease are critical factors influencing mortality in primary prevention ICD patients.
Aims:
To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator (ICD) for primary prevention in terms of mortality, morbidity and appropriate and inappropriate interventions. Secondly, to compare the performances of single-chamber vs. dual-chamber devices.
Methods:
We examined all patients with CAD or CMD who received an ICD in primary prevention with at least 6 months of follow-up. For each patient were evaluated, primarily, survival, complications related to the implantation and performance of the device (antitachycardia pacing/shock).
Results:
Of 193 patients, 163 were men (84.5). Mean age was 64.4 ± 10 years. One hundred and twenty patients (62%) were affected by CAD and 73 (38%) by CMD. The ejection fraction was 26 ± 6%. Fifty-three patients (27.5%) received a dual-chamber ICD, whereas 140 (72.5%) received a single-chamber ICD. There were periprocedural complications in 5.2% of the patients. At a mean follow-up of 49.9 months, 55 patients (28.5%) died. Appropriate interventions were documented in 40 patients (20.7%). In 36 patients (18%), inappropriate interventions occurred. Patients implanted with dual-chamber ICD had an overall mortality of 17% compared to 32.4% for those implanted with single-chamber ICD (P = 0.029). Mortality was higher in patients with CAD (33.9%) (P = 0.032). Among the fatalities, 69% occurred in patients who had an ejection fraction 25% or less at the time of implantation and 31% in patients with an ejection fraction greater than 25% (P = 0.013).
Conclusions:
The 4-year survival was 72%. The overall mortality was higher in patients with CAD. More than two-thirds of the deceased had an ejection fraction less than 25%. The dual-chamber ICD patients had a significantly lower mortality rate.
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