Abstract 13672: No Benefit of a Dual Coil over a Single Coil ICD Lead: Evidence from SCD-HeFT
Background: Dual coil ICD leads (with a superior vena cava (SVC) electrode) have been considered standard of care. Their use is predicated on the belief that ICD defibrillation efficacy is improved based upon very small studies from the 1990s. SVC coils increase the complexity of ICD lead construction and are an additional component that can result in transvenous lead failure. Moreover, the SVC coil is associated with an active fibrotic reaction in a vulnerable area of the SVC increasing the risk during lead extraction procedures of perforation and death.
Purpose: To compare all cause mortality, first shock efficacy, appropriate shocks, and implant defibrillation test energies in recipients of dual coil vs. single coil ICD leads. The population studied derives from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).
Methods: In SCD-HeFT, 811 heart failure patients received a single lead transvenous ICD and underwent protocol driven defibrillation testing. Complete data were available in 717 patients. Selection of dual vs. single coil RV lead systems was left to the discretion of the implanting physician. All ICDs were Medtronic model 7223.
Results: A dual coil (RV+SVC) was used in 563 patients and a single RV coil in 246 patients. After a median follow-up of 45.5 months, mortality in the two ICD lead groups was 19.4% vs. 21.5% (RV+SVC vs. RV) adjusted HR=0.95 (0.68, 1.33) p=0.77. First shock efficacy was 79.8% vs. 90.5% (RV+SVC vs. RV) unadjusted OR=0.42 (0.16, 1.08) p=0.066. Appropriate shocks for VT or VF were 21.1% (119/563) vs. 25.6% (63/246) (RV+SVC vs. RV) unadjusted HR=0.83 (0.61, 1.12) p=0.23. Mean DFT was 12.1 + 4.7J vs. 12.8 + 4.8J (RV+SVC vs. RV) p=0.087 and did not differ by lead type in those with appropriate shocks, p=0.96.
Conclusions: In patients who received a primary prevention ICD, the addition of an SVC coil for left sided implants did not improve outcomes. No significant difference in all cause mortality, first shock efficacy for VT/VF, or defibrillation efficacy at implant was observed. Given the complexity and cost of transvenous lead construction and the higher risk of lead failure and extraction-related complications with dual coil leads, we advocate a return to the single coil RV ICD lead for left sided ICD implantation as the standard of care.
- © 2010 by American Heart Association, Inc.