Utilization trends and clinical outcomes in patients implanted with a single- vs a dual-coil implantable cardioverter-defibrillator lead: Insights from the ALTITUDE Study.
BACKGROUND
Historically, the most commonly implanted implantable cardioverter-defibrillator (ICD) lead is dual coil. Conventional wisdom holds that single-coil leads may be less effective than dual-coil leads, but easier to extract. No contemporary large-scale studies have evaluated the relative epidemiology of these 2 leads or compared their respective clinical outcomes.


OBJECTIVE
We sought to evaluate trends in single- vs dual-coil ICD lead implantation and differences in clinical outcomes.


METHODS
We evaluated 129,520 ICD recipients enrolled in the LATITUDE remote monitoring system between 2004 and 2014. Kaplan-Meier analyses and Cox proportional hazards regression analyses were used for univariate and multivariate survival analysis, respectively.


RESULTS
The majority of ICD recipients received a dual-coil lead (n = 110,330 [85.2%]). Single-coil lead implantation increased from 1.9% to 55.2% between 2004 and 2014. After adjusting for age, sex, device type, and year of implant, single-coil lead implantation was associated with a greater odds of induction for defibrillation testing (odds ratio 1.05; 95% confidence interval [CI] 1.01-1.09; P = .0274), a higher rate of lead being taken out of service (hazard ratio 1.19; 95% CI 1.06-1.33; P = .0032), and a decreased mortality rate (hazard ratio 0.91; 95% CI 0.87-0.96; P = .0004). In a 795 patient subset with adjudicated shock outcomes, first shock success was no different (87.0% in single coil vs 86.1% in dual coil; P = .8473).


CONCLUSIONS
In a large real-world US population, single-coil lead implantation rates increased substantially between 2004 and 2014. Single-coil lead implantation was associated with more frequent defibrillation testing and the lead being taken out of service, but was not associated with increased mortality or more frequent defibrillation failure.
Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California. Electronic address: Jonathan.Hsu@ucsd.edu.
Jonathan C
JC
Hsu
Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Leslie A
LA
Saxon
Biostatistics, Boston Scientific, St. Paul, Minnesota.
Paul W
PW
Jones
Biostatistics, Boston Scientific, St. Paul, Minnesota.
Scott
S
Wehrenberg
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California.
Gregory M
GM
Marcus
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000706:statistics & numerical data*; D004867:Equipment Design / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012769:Shock / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Cardiac resynchronization therapy; Dual coil; Implantable cardioverter-defibrillator; Lead; Mortality; Shock; Single coil