{"id":36678,"date":"2013-05-14T16:28:26","date_gmt":"2013-05-14T20:28:26","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=36678"},"modified":"2013-05-14T16:28:26","modified_gmt":"2013-05-14T20:28:26","slug":"study-questions-role-of-dual-chamber-icds-for-primary-prevention","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/05\/14\/study-questions-role-of-dual-chamber-icds-for-primary-prevention\/","title":{"rendered":"Study Questions Role of Dual-Chamber ICDs for Primary Prevention"},"content":{"rendered":"<p>The majority of patients who receive an ICD for primary prevention without a pacing indication have a dual-chamber ICD implanted. Although there are a number of theoretical advantages with dual-chamber devices, they are more likely to cause complications than single-chamber devices. Although CMS requires providers to justify the medical necessity of dual-chamber devices, current guidelines from the AHA\/ACC and HRS do not specify a single-chamber device.<\/p>\n<p><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1687578\">In a new study published in\u00a0<em>JAMA<\/em><\/a>,\u00a0Pamela Peterson and colleagues analyzed data from 32,000 patients enrolled in the National Cardiovascular Data Registry (NCDR) who received an ICD for primary prevention without a pacing indication. Of these, 38% received a single-chamber device and 62% received a dual-chamber device. At 1 year there were no significant differences in\u00a0mortality, all-cause hospitalization, or heart failure hospitalization between the two groups. However, patients in the dual-chamber group had a higher risk of complications, including a highly significant increase in the 90-day risk of mechanical complications requiring re-operation (1.43% in the single-chamber group versus 2.02% in the dual-chamber group, p&lt;0.001). A very similar pattern emerged when the investigators performed an analysis that matched patients in the two groups with a propensity model. The\u00a0analysis suggested &#8220;that the choice of a dual-chamber device is relatively random with respect to patient characteristics&#8230;&#8221;<\/p>\n<p>In their discussion the authors noted that dual-chamber devices are more expensive than single-chamber devices and are also likely to increase costs through more complications and a greater risk of generator depletion. &#8220;Our study does not provide evidence that would support the more costly and more morbid device for patients receiving an ICD for primary prevention,&#8221; they wrote.<\/p>\n<p>The authors concluded:<\/p>\n<blockquote><p>\u201cMany patients receiving primary prevention ICDs receive dual-chamber devices. Dual-chamber devices do not appear to offer any clinical benefit over single-chamber devices with regard to death, all-cause readmission, or heart failure readmission in the year following implant. However, dual-chamber ICDs are associated with higher rates of complications. Therefore, among patients without clear pacing indications, the decision to implant a dual-chamber ICD for primary prevention should be considered carefully.\u201d<\/p><\/blockquote>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The majority of patients who receive an ICD for primary prevention without a pacing indication have a dual-chamber ICD implanted. Although there are a number of theoretical advantages with dual-chamber devices, they are more likely to cause complications than single-chamber devices. Although CMS requires providers to justify the medical necessity of dual-chamber devices, current guidelines [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,7],"tags":[516,681,448,638],"class_list":["post-36678","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-prevention","tag-cost-effectiveness","tag-icd-leads","tag-icds","tag-ncdr"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36678","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=36678"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36678\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=36678"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=36678"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=36678"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}