Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California.
Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Heart Rhythm. 2015 Aug;12(8):1770-5. doi: 10.1016/j.hrthm.2015.04.030. Epub 2015 Apr 24.
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.
We sought to evaluate trends in single- vs dual-coil ICD lead implantation and differences in clinical outcomes.
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.
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).
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.
历史上，最常植入的植入式心律转复除颤器（ICD）导联是双线圈。传统观点认为，单线圈导联可能不如双线圈导联有效，但更容易拔出。目前尚无大规模研究评估这两种导联的相对流行病学，也没有比较它们各自的临床结果。
我们旨在评估单线圈与双线圈 ICD 导联植入的趋势以及临床结果的差异。
我们评估了 2004 年至 2014 年间 LATITUDE 远程监测系统中 129520 例 ICD 接受者。Kaplan-Meier 分析和 Cox 比例风险回归分析分别用于单变量和多变量生存分析。
大多数 ICD 接受者植入了双线圈导联（n=110330[85.2%]）。2004 年至 2014 年间，单线圈导联植入的比例从 1.9%增加到 55.2%。在调整年龄、性别、设备类型和植入年份后，单线圈导联植入与更频繁地进行除颤测试诱导的可能性更大（比值比 1.05；95%置信区间 [CI] 1.01-1.09；P=.0274），更有可能停用导联（风险比 1.19；95%CI 1.06-1.33；P=.0032），且死亡率降低（风险比 0.91；95%CI 0.87-0.96；P=.0004）。在具有裁定性休克结局的 795 例患者亚组中，首次电击成功率无差异（单线圈为 87.0%，双线圈为 86.1%；P=.8473）。
在一项大型美国真实世界人群中，2004 年至 2014 年间，单线圈导联植入率大幅增加。单线圈导联植入与更频繁的除颤测试和导联停用有关，但与死亡率增加或更频繁的除颤失败无关。
