title: Clinical impact, safety, and efficacy of single- versus dual-coil ICD leads in MADIT-CRT.
abstract: BACKGROUND
  Current data on efficacy, safety and impact on clinical outcome of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads are limited and contradictory.
  
  
  METHODS
  Defibrillation threshold (DFT) at implantation and first shock efficacy were compared in patients implanted with single- versus dual-coil ICD leads in MADIT-CRT. The risk for atrial tachyarrhythmias and all-cause mortality were evaluated. Short- (< 30 days after the implantation) and long-term (throughout the entire study duration) complications were assessed.
  
  
  RESULTS
  Patients with dual-coil ICD leads had significantly lower DFTs compared to patients with single-coil ICD leads (17.6 ± 5.8 J vs 19.4 ± 6.1 J, P < 0.001). First shock efficacy was similar among patients with dual and single-coil ICD leads (89.6% vs 92.3%, P = 1.00). When comparing patients with dual versus single-coil ICD leads, there was no difference in the risk of atrial tachyarrhythmias (HR = 1.57, 95% CI: 0.81-3.02, P = 0.18), or in the risk of all-cause mortality (HR = 1.10, 95% CI: 0.58-2.07, P = 0.77). Patients implanted with single- or dual-coil ICD lead had similar short and long-term complication rates (short-term HR = 0.96, 95% CI: 0.56-1.65, P = 0.88, long-term procedure-related HR = 0.99, 95% CI: 0.62-1.59, P = 1.00, long-term ICD lead related: HR = 1.2, 95% CI: 0.5-2.9, P = 0.68) during the mean follow-up of 3.3 years.
  
  
  CONCLUSIONS
  Patients with single-coil ICD leads have slightly higher DFTs compared to those with dual-coil leads, but the efficacy, safety, and clinical impact on atrial tachyarrhythmias, and mortality is similar. Implantation of single-coil ICD leads may be favorable in most patients.
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY, USA; Semmelweis University Heart Center, Budapest, Hungary.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Huth Ruwald
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Aktas
authors.forename: Christian
authors.initials: C
authors.lastname: Jons
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.forename: Laszlo
authors.initials: L
authors.lastname: Geller
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Bloch Thomsen
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: MADIT-CRT mortality; atrial arrhythmias; heart failure; implantable cardioverter defibrillators