Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
JACC Clin Electrophysiol. 2017 Jan;3(1):12-19. doi: 10.1016/j.jacep.2016.06.007. Epub 2016 Sep 7.
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.
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.
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.
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).
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.
本研究旨在进行荟萃分析，比较单线圈和双线圈植入式心脏复律除颤器（ICD）系统的除颤阈值（DFT）和结果。
与经静脉 ICD 系统相比，使用双线圈除颤器导联可能会降低 DFT；然而，双线圈 ICD 可能会有更高的导联相关并发症。
使用预设的检索词进行全面的文献检索，并通过交叉引用进行额外检索后，共纳入了 16 项研究，每项研究均有 10 多名受试者。使用 R 统计软件对来自这些研究的数据进行异质性检验、合并和荟萃分析。使用随机效应模型进行荟萃分析。
对 14 项研究中 DFT 差异的数据分析显示，单线圈和双线圈 ICD 之间平均 DFT 的估计差值为 0.81 J（95%置信区间 [CI]：0.31 至 1.30 J），因此双线圈 ICD 更有优势。然而，5 项研究的汇总数据显示，双线圈 ICD 与单线圈 ICD 相比，首次电击效果无差异（估计总体优势比：0.94；95%CI：0.49 至 1.78；p = 0.85）。4 项研究分析的全因死亡率在单线圈 ICD 患者中较低（估计风险比：0.91；95%CI：0.83 至 0.99）。
经静脉 ICD 单线圈和双线圈导联系统的 DFT 之间存在微小差异。然而，两组之间首次电击效果没有差异，基于非随机研究数据，单线圈 ICD 患者的全因死亡率更有利。应仔细权衡单线圈和双线圈 ICD 导联的潜在风险和获益。
