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Single-brand dual-chamber discriminators to prevent inappropriate shocks in patients implanted with prophylactic implantable cardioverter defibrillators: a propensity-weighted comparison of single- and dual-chamber devices

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Comparisons of the efficacy of dual- vs. single-chamber implantable cardioverter defibrillators (ICDs) in preventing inappropriate shocks have had contradictory results. We investigated whether dual-chamber devices have a lower risk of inappropriate shocks and the specific role of supraventricular tachycardia (SVT) discriminators.

Methods

All heart failure (HF) patients without an indication for pacing and implanted with a prophylactic ICD were recruited from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.

Results

Among 782 patients, single-chamber ICDs were implanted in 537 (68.7%) and dual-chamber devices in 245 (31.3%). During a mean follow-up of 52.2 ± 24.5 months, 109 inappropriate shocks were delivered in 49 patients (6.2%). In the propensity-score-matched analysis, dual-chamber ICDs were related to lower rates of inappropriate shocks as compared to single-chamber devices (0.9% vs. 11.8%, p = < 0.001, log-rank test). In multivariable Cox proportional analysis, independent predictors of inappropriate shock were history of atrial fibrillation (hazard ratio (HR) = 2.78, CI 1.37–5.64, p = 0.004), chronic kidney disease (HR = 6.15, CI 2.82–13.53, p < 0.001), and non-ischemic cardiomyopathy (HR = 2.84, CI 1.54–5.23, p = 0.001). Among ICD settings, PR logic was the only discriminator independently related to a reduced risk of inappropriate shocks (HR = 0.18, CI 0.06–0.48, p = 0.001), along with an SVT limit enabled over 200 bpm (HR = 0.24, CI 0.11–0.51, p < 0.001).

Conclusions

In this nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were related to lower risk of inappropriate shocks compared to single-chamber ICDs. Besides, PR logic and SVT limit > 200 bpm emerged as protective factors.

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Acknowledgments

The authors acknowledge the Spanish Scoop team, especially Alba García, Esther Sastre, and Cristina Álvarez.

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Authors and Affiliations

  1. Cardiology Department, Hospital Universitario Infanta Leonor, Gran Vía del Este, 28030, Madrid, Spain

    Sem Briongos-Figuero, Ana Sánchez & Roberto Muñoz-Aguilera

  2. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain

    M. Luisa Pérez

  3. Hospital Universitario de Áraba, Vitoria-Gasteiz, Álava, Spain

    José B. Martínez-Ferrer

  4. Complejo Hospitalario Universitario de Vigo, Vigo, Spain

    Enrique García

  5. Hospital Santa Creu i Sant Pau, Barcelona, Spain

    Xavier Viñolas

  6. Hospital Universitario Gregorio Marañón, Madrid, Spain

    Ángel Arenal

  7. Hospital Virgen de la Victoria, Málaga, Spain

    Javier Alzueta

  8. Complejo Hospitalario de Navarra, Pamplona, Spain

    Nuria Basterra

  9. Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

    Aníbal Rodríguez

  10. Hospital Universitario Puerta de Hierro, Madrid, Spain

    Ignacio Lozano

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  1. Sem Briongos-Figuero
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  2. Ana Sánchez
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Correspondence to Sem Briongos-Figuero.

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Briongos-Figuero, S., Sánchez, A., Pérez, M.L. et al. Single-brand dual-chamber discriminators to prevent inappropriate shocks in patients implanted with prophylactic implantable cardioverter defibrillators: a propensity-weighted comparison of single- and dual-chamber devices. J Interv Card Electrophysiol 54, 267–275 (2019). https://doi.org/10.1007/s10840-018-0494-0

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