Open Access

Outcomes with single-coil versus dual-coil implantable cardioverter defibrillators: a meta-analysis

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Date: 27 February 2017
Journal: EP Europace Journal , Volume 20 , Issue 3 , Pages e21 - e29
Authors: N. Sunderland , A. Kaura , F. Murgatroyd , P. Dhillon , P. Scott

ESC Journals

AbstractAims

Dual-coil implantable cardioverter defibrillator (ICD) leads have traditionally been used over single-coil leads due to concerns regarding high defibrillation thresholds (DFT) and consequent poor shock efficacy. However, accumulating evidence suggests that this position may be unfounded and that dual-coil leads may also be associated with higher complication rates during lead extraction. This meta-analysis collates data comparing dual- and single-coil ICD leads.

Methods and results

Electronic databases were systematically searched for randomized controlled trials (RCT) and non-randomized studies comparing single-coil and dual-coil leads. The mean differences in DFT and summary estimates of the odds-ratio (OR) for first-shock efficacy and the hazard-ratio (HR) for all-cause mortality were calculated using random effects models. Eighteen studies including a total of 138,124 patients were identified. Dual-coil leads were associated with a lower DFT compared to single coil leads (mean difference –0.83J; 95% confidence interval [CI] –1.39––0.27; P = 0.004). There was no difference in the first-shock success rate with dual-coil compared to single-coil leads (OR 0.74; 95%CI 0.45–1.21; P=0.22). There was a significantly lower risk of all-cause mortality associated with single-coil leads (HR 0.91; 95%CI 0.86–0.95; P < 0.0001).

Conclusion

This meta-analysis suggests that single-coil leads have a marginally higher DFT but that this may be clinically insignificant as there appears to be no difference in first-shock efficacy when compared to dual-coil leads. The mortality benefit with single-coil leads most likely represents patient selection bias. Given the increased risk and complexity of extracting dual-coil leads, centres should strongly consider single-coil ICD leads as the lead of choice for routine new left-sided ICD implants.

About the contributors

Nicholas Sunderland

Role: Author

Amit Kaura

Role: Author

Francis Murgatroyd

Role: Author