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Shock efficacy of single and dual coil electrodes - New insights from the NORDIC ICD Trial

Bänsch, Dietmar ; Bonnemeier, Hendrik ; Brandt, Johan LU ; Bode, Frank ; Svendsen, Jesper Hastrup ; Ritter, Oliver ; Aring, Johannes ; Gutleben, Klaus Jürgen ; Schneider, Ralph and Felk, Angelika , et al. (2018) In Europace 20(6). p.971-978
Abstract

Aims Dual coil (DC) electrodes are preferred to single coil (SC) electrodes because of an assumed higher shock efficacy. However, DC-electrodes may be associated with an increased difficulty and risk of lead extraction. We aimed to compare SC- and DC-electrodes with respect to the first shock efficacy (FSE) after implantable cardioverter defibrillator (ICD) implantation. Methods and results One thousand and seventy-seven patients of the NORDIC ICD trial were randomly assigned to first time ICD implantation with or without defibrillation (DF) testing. The electrode configuration was determined before randomization. One thousand and sixty-seven patients eventually received an ICD, 516 (48.4%) with a SC- and 551 (51.6%) with a... (More)

Aims Dual coil (DC) electrodes are preferred to single coil (SC) electrodes because of an assumed higher shock efficacy. However, DC-electrodes may be associated with an increased difficulty and risk of lead extraction. We aimed to compare SC- and DC-electrodes with respect to the first shock efficacy (FSE) after implantable cardioverter defibrillator (ICD) implantation. Methods and results One thousand and seventy-seven patients of the NORDIC ICD trial were randomly assigned to first time ICD implantation with or without defibrillation (DF) testing. The electrode configuration was determined before randomization. One thousand and sixty-seven patients eventually received an ICD, 516 (48.4%) with a SC- and 551 (51.6%) with a DC-electrode. DC-electrodes were preferentially selected in older patients, renal failure, atrial fibrillation, dual chamber, Cardiac Resynchronization Therapy (CRT) devices, angiotensin-converting-enzyme (ACE) inhibitors/angiotensin (AT) receptor blockers and without Sotalol. However, the preference of the investigational site was dominant over clinical parameters. The DF energy at the final electrode position was higher in SC-electrodes (adjusted difference +1.15 J; P = 0.005; only patients tested). Less patients with DC-electrodes required intra-operative system reconfiguration (adjusted difference -3.9; P = 0.046; only patients tested). Using mixed logistic regression, the FSE was 92.6% in SC- and 97.8% in DC-electrodes (adjusted odds ratio 4.3 (95% confidence interval [1.9, 9.8]; P < 0.001)). Conclusion Dual coil-electrode selection mainly depends on the preference of the investigational site and seems to be preferred in older patients, renal failure, atrial fibrillation, dual chamber, and CRT devices. Patients with DC-electrodes required less intraoperative system reconfigurations. Dual coil-electrodes provided a substantially higher FSE during follow-up. Mortality rates were not significantly different in patients with DC- and SC-electrodes.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Defibrillation, Defibrillation testing, Electrodes, Implantable cardioverter-defibrillator
in
Europace
volume
20
issue
6
pages
8 pages
publisher
Oxford University Press
external identifiers
  • pmid:28419217
  • scopus:85048062036
ISSN
1099-5129
DOI
10.1093/europace/eux075
language
English
LU publication?
no
id
364dea46-7afd-4ebc-84df-970a421fdfdd
date added to LUP
2018-06-19 13:50:03
date last changed
2020-10-27 02:18:40
@article{364dea46-7afd-4ebc-84df-970a421fdfdd,
  abstract     = {<p>Aims Dual coil (DC) electrodes are preferred to single coil (SC) electrodes because of an assumed higher shock efficacy. However, DC-electrodes may be associated with an increased difficulty and risk of lead extraction. We aimed to compare SC- and DC-electrodes with respect to the first shock efficacy (FSE) after implantable cardioverter defibrillator (ICD) implantation. Methods and results One thousand and seventy-seven patients of the NORDIC ICD trial were randomly assigned to first time ICD implantation with or without defibrillation (DF) testing. The electrode configuration was determined before randomization. One thousand and sixty-seven patients eventually received an ICD, 516 (48.4%) with a SC- and 551 (51.6%) with a DC-electrode. DC-electrodes were preferentially selected in older patients, renal failure, atrial fibrillation, dual chamber, Cardiac Resynchronization Therapy (CRT) devices, angiotensin-converting-enzyme (ACE) inhibitors/angiotensin (AT) receptor blockers and without Sotalol. However, the preference of the investigational site was dominant over clinical parameters. The DF energy at the final electrode position was higher in SC-electrodes (adjusted difference +1.15 J; P = 0.005; only patients tested). Less patients with DC-electrodes required intra-operative system reconfiguration (adjusted difference -3.9; P = 0.046; only patients tested). Using mixed logistic regression, the FSE was 92.6% in SC- and 97.8% in DC-electrodes (adjusted odds ratio 4.3 (95% confidence interval [1.9, 9.8]; P &lt; 0.001)). Conclusion Dual coil-electrode selection mainly depends on the preference of the investigational site and seems to be preferred in older patients, renal failure, atrial fibrillation, dual chamber, and CRT devices. Patients with DC-electrodes required less intraoperative system reconfigurations. Dual coil-electrodes provided a substantially higher FSE during follow-up. Mortality rates were not significantly different in patients with DC- and SC-electrodes.</p>},
  author       = {Bänsch, Dietmar and Bonnemeier, Hendrik and Brandt, Johan and Bode, Frank and Svendsen, Jesper Hastrup and Ritter, Oliver and Aring, Johannes and Gutleben, Klaus Jürgen and Schneider, Ralph and Felk, Angelika and Hauser, Tino and Buchholz, Anika and Hindricks, Gerhard and Wegscheider, Karl},
  issn         = {1099-5129},
  language     = {eng},
  month        = {06},
  number       = {6},
  pages        = {971--978},
  publisher    = {Oxford University Press},
  series       = {Europace},
  title        = {Shock efficacy of single and dual coil electrodes - New insights from the NORDIC ICD Trial},
  url          = {http://dx.doi.org/10.1093/europace/eux075},
  doi          = {10.1093/europace/eux075},
  volume       = {20},
  year         = {2018},
}