Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark.
Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark.
Heart Rhythm. 2016 Mar;13(3):706-12. doi: 10.1016/j.hrthm.2015.11.034. Epub 2015 Nov 22.
The best choice of defibrillator lead in patients with routine implantable cardioverter-defibrillator (ICD) is not settled. Traditionally, most physicians prefer dual-coil leads but the use of single-coil leads is increasing.
The purpose of this study was to compare clinical outcomes in patients with single- and dual-coil leads.
All 4769 Danish patients 18 years or older with first-time ICD implants from 2007 to 2011 were included from the Danish Pacemaker and ICD Register. Defibrillator leads were 38.9% single-coil leads and 61.1% dual-coil leads. The primary end point was all-cause mortality. Secondary end points were lowest successful energy at implant defibrillation testing, first shock failure in spontaneous arrhythmias, structural lead failure, and lead extraction outcomes.
Single-coil leads were associated with lower all-cause mortality with an adjusted hazard ratio of 0.85 (95% confidence interval 0.73-0.99; P = .04). This finding was robust in a supplementary propensity score-matched analysis. However, dual-coil leads were used in patients with slightly higher preimplant morbidity, making residual confounding by indication the most likely explanation for the observed association between lead type and mortality. The lowest successful defibrillation energy was higher using single-coil leads (23.2 ± 4.3 J vs 22.1 ± 3.9 J; P < .001). No significant differences were observed for other secondary end points showing high shock efficacies and low rates of lead failures and extraction complications.
Shock efficacy is high for modern ICD systems. The choice between single-coil and dual-coil defibrillator leads is unlikely to have a clinically significant impact on patient outcomes in routine ICD implants.
在接受常规植入式心脏复律除颤器（ICD）治疗的患者中，最佳的除颤器导联选择尚未确定。传统上，大多数医生更喜欢双线圈导联，但单线圈导联的使用正在增加。
本研究旨在比较单线圈和双线圈导联患者的临床结局。
从 2007 年至 2011 年，丹麦起搏器和 ICD 注册中心共纳入 4769 名年龄在 18 岁及以上的首次植入 ICD 的丹麦患者。除颤器导联 38.9%为单线圈导联，61.1%为双线圈导联。主要终点为全因死亡率。次要终点为植入时除颤测试的最低有效能量、自发性心律失常的首次电击失败、结构性导联失败和导联拔除结局。
单线圈导联与全因死亡率降低相关，调整后的风险比为 0.85（95%置信区间 0.73-0.99；P =.04）。这一发现在补充倾向评分匹配分析中是稳健的。然而，双线圈导联用于具有稍高的植入前发病率的患者，因此，导联类型与死亡率之间的观察到的关联最有可能是由残余混杂引起的。单线圈导联的最低有效除颤能量更高（23.2 ± 4.3 J 比 22.1 ± 3.9 J；P <.001）。其他次要终点没有观察到显著差异，显示出高电击疗效和低导联失败及拔除并发症发生率。
现代 ICD 系统的电击疗效很高。在常规 ICD 植入中，单线圈和双线圈除颤器导联的选择不太可能对患者的临床结局产生显著影响。
