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on August 23, 2004

A more recent version of this article appeared on August 31, 2004

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Submitted on March 27, 2003
Revised on March 30, 2004
Accepted on April 13, 2004

The 1+1 Trial. A Prospective Trial of a Dual- Versus a Single-Chamber Implantable Defibrillator in Patients With Slow Ventricular Tachycardias

Dietmar Bänsch MD^*, Frank Steffgen , Gerian Grönefeld MD, Christian Wolpert MD, Dirk Böcker MD, Ralph-Uwe Mletzko MD, Wolfgang Schöls MD, Karlheinz Seidl MD, Michael Piel , Feifan Ouyang MD, Stefan H. Hohnloser MD, and Karl-Heinz Kuck MD

From the Department of Cardiology, St Georg Hospital, Hamburg (D. Bänsch, F.O., K.K.); ELA Medical, Munich (F.S., M.P.); Department of Cardiology, University Hospital, Frankfurt (G.G., S.H.H.); Department of Cardiology, University Hospital, Mannheim (C.W.); Department of Cardiology and Angiology and Institute for Research in Arteriosclerosis, Westfälische Wilhelms University, Münster (D. Böcker); Department of Cardiology, Clinic for Cardiovascular Disease, Bad Bevensen (R.M.); Department of Cardiology, Ruprecht-Karls University, Heidelberg (W.S.); and Department of Cardiology, University Clinic, Ludwigshafen (K.S.), Germany.

^* To whom correspondence should be addressed. E-mail: BAE151162{at}AOL.com.

Background--The tachycardia detection interval (TDI) in implantable cardioverter/defibrillators (ICDs) is conventionally programmed according to the slowest documented ventricular tachycardia (VT), with a safety margin of 30 to 60 ms. With this margin, VTs above the TDI may occur. However, longer TDIs are associated with an increased risk of inappropriate therapy. We hypothesized that patients with slow VTs (<200 bpm) may benefit from a long TDI and a dual-chamber detection algorithm compared with a conventionally programmed single-chamber ICD.

Methods and Results--Patients with VTs <200 bpm were implanted with a dual-chamber ICD that was randomly programmed to a dual-chamber algorithm and a TDI of 469 ms or to a single-chamber algorithm with a TDI 30 to 60 ms above the slowest documented VT cycle length and the enhancement criteria of cycle length variation and acceleration. The primary combined end point was the number of all inappropriate therapies, VTs above the TDI, and VTs with significant therapy delay (>2 minutes). After 6 months, a crossover analysis was performed. Total follow-up was 1 year. One hundred two patients were included in the study. The programmed TDI was 500±36 ms during the dual-chamber phase and 424±63 ms during the single-chamber phase. For the primary end point (inappropriate therapies, VTs above the TDI, or VTs with detection delay), a moderate superiority of the dual-chamber mode was found: Mann-Whitney estimator=0.6661; 95% CI, 0.5565 to 0.7758; P=0.0040.

Conclusions--Dual-chamber detection with a longer TDI improves VT detection and does not increase the rate of inappropriate therapies despite a considerable increase in tachycardia burden.

Key words: algorithms • defibrillators, implantable • tachycardia, ventricular

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