Outcomes of single- or dual-chamber implantable cardioverter defibrillator systems in Japanese patients

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• 作者：Akiko Ueda^a ; ^{akiko.ut23@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Yasushi Oginosawa^b ; ^{y-ogi@med.uoeh-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kyoko Soejima^a ; ^{kyoko@cpnet.med.keio.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; ^{skyoko@ks.kyorin-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} (Professor/Director of Cardiac Arrhythmia Centre) ; Haruhiko Abe^c ; ^{haru-abe@med.uoeh-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Ritsuko Kohno^c ; ^{r-kohno@med.uoeh-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hisaharu Ohe^b ; ^{hisa0523@hotmail.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Yuichi Momose^a ; ^{medteni0624@yahoo.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Mika Nagaoka^a ; ^{mnndisk.a-ni-@ezweb.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Noriko Matsushita^a ; ^{norikom627@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kyoko Hoshida^a ; ^{kyokohsd@yahoo.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Yosuke Miwa^a ; ^{y-miwa@ks.kyorin-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Mutsumi Miyakoshi^a ; ^{mya623@ks.kyorin-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Ikuko Togashi^a ; ^{togatoga56@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Akiko Maeda^a ; ^{aki_kase@yahoo.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Toshiaki Sato^a ; ^{tosh1akisat00@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Hideaki Yoshino^a ; ^{yoshino@ks.kyorin-u.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Single-chamber ICD ; Dual-chamber ICD ; Pacing dependency
• 刊名：Journal of Arrhythmia
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：2
• 页码：89-94
• 全文大小：345 K

文摘

There are no criteria for selecting single- or dual-chamber implantable cardioverter defibrillators (ICDs) in patients without a pacing indication. Recent reports showed no benefit of the dual-chamber system despite its preference in the United States. As data on ICD selection and respective outcomes in Japanese patients are scarce, we investigated trends regarding single- and dual-chamber ICD usage in Japan.

Methods

Data from a total of 205 ICD recipients with structural heart disease (median age, 63 years) in two Japanese university hospitals were reviewed. Patients with bradycardia with a pacing indication and permanent atrial fibrillation at implantation were excluded.

Results

Single- and dual-chamber ICDs were implanted in 36 (18%) and 169 (82%) patients, respectively. Non-ischemic cardiomyopathy dominated both groups. Seventeen dual-chamber patients developed atrial pacing-dependency over 4.5 years, and it developed immediately after implantation in 14. Although preoperative testing showed no sign of bradycardia in these patients, their pacing rate was set higher than it was in patients who were pacing-independent (61 vs. 46 paces per min, p<0.01). Two single-chamber patients (5%) underwent atrial lead insertion.

While inappropriate shock equally occurred in both groups (7 vs. 21 patients, single- vs. dual-chamber, P=0.285), device-related infection occurred only in dual-chamber patients (0 vs. 9 patients, P=0.155). No differences in death or heart failure hospitalization were observed between groups.

Conclusions

Dual-chamber ICDs were four-fold more common in Japanese patients without a pacing indication. No benefit over single-chamber ICD was observed. Newly developed atrial pacing-dependency seemed to be limited and could have been overestimated due to higher pacing rate settings in dual-chamber patients.