Comparison of Single-Coil and Dual-Coil Implantable Defibrillators: A Meta-Analysis

Prabhat Kumar, Matthew Baker, Anil K. Gehi

Research output: Contribution to journalArticle

  • 3 Citations

Abstract

Objectives The purpose of this investigation was to conduct a meta-analysis of studies comparing defibrillation threshold (DFT) and outcomes with single-coil and dual-coil implantable cardioverter-defibrillator (ICD) systems. Background Use of dual-coil rather than single-coil defibrillator leads may lower the DFT with a transvenous ICD system; however, dual-coil ICDs may have higher lead-related complications. Methods Sixteen studies, each with more than 10 human subjects, that compared single-coil and dual-coil ICD systems were included for the final analysis after a comprehensive publication search using predefined search terms and additional search from cross-references. A test of heterogeneity, pooling, and meta-analysis of the data from the studies were performed using R statistical software. A random effects model was used for meta-analysis. Results Data pooled from 14 studies analyzed for difference in DFT showed an estimated difference in mean DFTs between single-coil and dual-coil ICDs of 0.81 J (95% confidence interval [CI]: 0.31 to 1.30 J), thus favoring dual-coil ICDs. However, pooled data from 5 studies revealed no difference in first-shock efficacy for dual-coil ICDs compared with single-coil ICDs (estimated overall odds ratio: 0.94; 95% CI: 0.49 to 1.78; p = 0.85). The all-cause mortality rate analyzed from 4 studies was lower in patients with single-coil ICDs (estimated hazard ratio: 0.91; 95% CI: 0.83 to 0.99). Conclusions There was a marginal difference in the defibrillation threshold of transvenous ICDs between single-coil and dual-coil lead systems. However, first-shock efficacy was no different between the 2 groups, and patients with single-coil ICDs had favorable all-cause mortality rates on the basis of data from nonrandomized studies. Potential risks and benefits of single-coil and dual-coil ICD leads should be carefully weighed.

LanguageEnglish (US)
Pages12-19
Number of pages8
JournalJACC: Clinical Electrophysiology
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Implantable Defibrillators
Meta-Analysis
Confidence Intervals
Shock
Defibrillators
Mortality
Publications
Software
Odds Ratio
Lead

Keywords

  • all-cause mortality
  • defibrillation threshold
  • dual-coil implantable cardioverter-defibrillator
  • implantable cardioverter-defibrillator
  • single-coil implantable cardioverter-defibrillator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Comparison of Single-Coil and Dual-Coil Implantable Defibrillators : A Meta-Analysis. / Kumar, Prabhat; Baker, Matthew; Gehi, Anil K.

In: JACC: Clinical Electrophysiology, Vol. 3, No. 1, 01.01.2017, p. 12-19.

Research output: Contribution to journalArticle

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abstract = "Objectives The purpose of this investigation was to conduct a meta-analysis of studies comparing defibrillation threshold (DFT) and outcomes with single-coil and dual-coil implantable cardioverter-defibrillator (ICD) systems. Background Use of dual-coil rather than single-coil defibrillator leads may lower the DFT with a transvenous ICD system; however, dual-coil ICDs may have higher lead-related complications. Methods Sixteen studies, each with more than 10 human subjects, that compared single-coil and dual-coil ICD systems were included for the final analysis after a comprehensive publication search using predefined search terms and additional search from cross-references. A test of heterogeneity, pooling, and meta-analysis of the data from the studies were performed using R statistical software. A random effects model was used for meta-analysis. Results Data pooled from 14 studies analyzed for difference in DFT showed an estimated difference in mean DFTs between single-coil and dual-coil ICDs of 0.81 J (95{\%} confidence interval [CI]: 0.31 to 1.30 J), thus favoring dual-coil ICDs. However, pooled data from 5 studies revealed no difference in first-shock efficacy for dual-coil ICDs compared with single-coil ICDs (estimated overall odds ratio: 0.94; 95{\%} CI: 0.49 to 1.78; p = 0.85). The all-cause mortality rate analyzed from 4 studies was lower in patients with single-coil ICDs (estimated hazard ratio: 0.91; 95{\%} CI: 0.83 to 0.99). Conclusions There was a marginal difference in the defibrillation threshold of transvenous ICDs between single-coil and dual-coil lead systems. However, first-shock efficacy was no different between the 2 groups, and patients with single-coil ICDs had favorable all-cause mortality rates on the basis of data from nonrandomized studies. Potential risks and benefits of single-coil and dual-coil ICD leads should be carefully weighed.",
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N2 - Objectives The purpose of this investigation was to conduct a meta-analysis of studies comparing defibrillation threshold (DFT) and outcomes with single-coil and dual-coil implantable cardioverter-defibrillator (ICD) systems. Background Use of dual-coil rather than single-coil defibrillator leads may lower the DFT with a transvenous ICD system; however, dual-coil ICDs may have higher lead-related complications. Methods Sixteen studies, each with more than 10 human subjects, that compared single-coil and dual-coil ICD systems were included for the final analysis after a comprehensive publication search using predefined search terms and additional search from cross-references. A test of heterogeneity, pooling, and meta-analysis of the data from the studies were performed using R statistical software. A random effects model was used for meta-analysis. Results Data pooled from 14 studies analyzed for difference in DFT showed an estimated difference in mean DFTs between single-coil and dual-coil ICDs of 0.81 J (95% confidence interval [CI]: 0.31 to 1.30 J), thus favoring dual-coil ICDs. However, pooled data from 5 studies revealed no difference in first-shock efficacy for dual-coil ICDs compared with single-coil ICDs (estimated overall odds ratio: 0.94; 95% CI: 0.49 to 1.78; p = 0.85). The all-cause mortality rate analyzed from 4 studies was lower in patients with single-coil ICDs (estimated hazard ratio: 0.91; 95% CI: 0.83 to 0.99). Conclusions There was a marginal difference in the defibrillation threshold of transvenous ICDs between single-coil and dual-coil lead systems. However, first-shock efficacy was no different between the 2 groups, and patients with single-coil ICDs had favorable all-cause mortality rates on the basis of data from nonrandomized studies. Potential risks and benefits of single-coil and dual-coil ICD leads should be carefully weighed.

AB - Objectives The purpose of this investigation was to conduct a meta-analysis of studies comparing defibrillation threshold (DFT) and outcomes with single-coil and dual-coil implantable cardioverter-defibrillator (ICD) systems. Background Use of dual-coil rather than single-coil defibrillator leads may lower the DFT with a transvenous ICD system; however, dual-coil ICDs may have higher lead-related complications. Methods Sixteen studies, each with more than 10 human subjects, that compared single-coil and dual-coil ICD systems were included for the final analysis after a comprehensive publication search using predefined search terms and additional search from cross-references. A test of heterogeneity, pooling, and meta-analysis of the data from the studies were performed using R statistical software. A random effects model was used for meta-analysis. Results Data pooled from 14 studies analyzed for difference in DFT showed an estimated difference in mean DFTs between single-coil and dual-coil ICDs of 0.81 J (95% confidence interval [CI]: 0.31 to 1.30 J), thus favoring dual-coil ICDs. However, pooled data from 5 studies revealed no difference in first-shock efficacy for dual-coil ICDs compared with single-coil ICDs (estimated overall odds ratio: 0.94; 95% CI: 0.49 to 1.78; p = 0.85). The all-cause mortality rate analyzed from 4 studies was lower in patients with single-coil ICDs (estimated hazard ratio: 0.91; 95% CI: 0.83 to 0.99). Conclusions There was a marginal difference in the defibrillation threshold of transvenous ICDs between single-coil and dual-coil lead systems. However, first-shock efficacy was no different between the 2 groups, and patients with single-coil ICDs had favorable all-cause mortality rates on the basis of data from nonrandomized studies. Potential risks and benefits of single-coil and dual-coil ICD leads should be carefully weighed.

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