Author + information
- Received October 11, 2016
- Revision received November 29, 2016
- Accepted November 29, 2016
- Published online June 19, 2017.
- Sean D. Pokorney, MD, MBAa,∗ (, )
- Craig S. Parzynski, MSb,
- James P. Daubert, MDa,
- Donald D. Hegland, MDa,
- Paul D. Varosy, MDc,
- Jeptha P. Curtis, MDb and
- Sana M. Al-Khatib, MD, MHSa
- aDuke University Medical Center, Durham, North Carolina
- bCenter for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, Connecticut
- cUniversity of Colorado Denver School of Medicine, Denver, Colorado
- ↵∗Address for correspondence:
Dr. Sean D. Pokorney, Electrophysiology Section, Duke University Medical Center, DUMC 3845, Durham, North Carolina 27710.
Objectives This analysis evaluated temporal trends and factors associated with the use of dual-coil implantable cardioverter-defibrillator (ICD) leads.
Background Data suggest that dual-coil ICD leads are not associated with lower mortality and can be more difficult to extract than single-coil leads.
Methods A total of 435,772 patients at 1,690 hospitals underwent ICD lead insertion in the National Cardiovascular Data Registry’s ICD Registry between April 2010 and December 2015. Hospitals were classified into 3 pre-specified groups (low, decreasing, or high use) based on the frequency of dual-coil lead use.
Results Nationally, the use of dual-coil leads has decreased over time, from 87% of ICD leads in early 2010 to 55% at the end of 2015. Hospitals in the low-use (n = 292) or decreasing-use (n = 561) group had more ICDs inserted by electrophysiologists compared to the high-use (n = 837) group (90% or 80% vs 46%; p < 0.001 for both) and more extractions performed (median 7 or 11 vs 2; p < 0.001 for both). Despite statistical differences, there were no clinically significant differences in patient characteristics across all 3 groups.
Conclusions Although the use of dual-coil ICD leads has decreased over time, it continues to represent the majority of insertions in the United States. Hospital-level factors, but not patient factors, were associated with use of dual-coil ICD leads. Whether decreasing dual-coil ICD lead use has improved patient outcomes remains unknown and should be examined in large, multicenter, contemporaneous patient groups.
Dr. Pokorney has served as a consultant/advisory board for Medtronic and Boston Scientific; and has received research grants form Gilead and Boston Scientific. Dr. Parzynski has received salary from American College of Cardiology NCDR. Dr. Daubert has received research grants from Medtronic, Boston Scientific, and Gilead; has received honoraria from Boston Scientific, Medtronic, Gilead, and Biosense Webster; and has served as a consultant/advisory board for Boston Scientific, Medtronic, and Biosense Webster. Dr. Curtis reports ownership in Medtronic; and has received salary from American College of Cardiology NCDR. All other authors have reported they have no relationships relative to the contents of this paper to disclose. The NCDR ICD Registry is an initiative of the American College of Cardiology Foundation with partnering support from the Heart Rhythm Society. The views expressed represent those of the author(s) and do not necessarily represent the official views of the NCDR or its associated professional societies (www.ncdr.com). Angelo Auricchio, MD, PhD, served as Guest Editor for this paper.
- Received October 11, 2016.
- Revision received November 29, 2016.
- Accepted November 29, 2016.
- 2017 American College of Cardiology Foundation