Temporal Trends in and Factors Associated With Use of Single- Versus Dual-Coil Implantable Cardioverter-Defibrillator Leads: Data From the NCDR ICD Registry.

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.

Duke Scholars

Author Sean Pokorney Medicine, Cardiology

Author James Patrick Daubert Medicine, Cardiology

Author Donald Dale Hegland Medicine, Cardiology

Author Sana Mustapha Al-Khatib Medicine, Cardiology