Utilization trends and clinical outcomes in patients implanted with a single- vs a dual-coil implantable cardioverter-defibrillator lead: Insights from the ALTITUDE Study

Heart Rhythm. 2015 Aug;12(8):1770-5. doi: 10.1016/j.hrthm.2015.04.030. Epub 2015 Apr 24.


Background: Historically, the most commonly implanted implantable cardioverter-defibrillator (ICD) lead is dual coil. Conventional wisdom holds that single-coil leads may be less effective than dual-coil leads, but easier to extract. No contemporary large-scale studies have evaluated the relative epidemiology of these 2 leads or compared their respective clinical outcomes.

Objective: We sought to evaluate trends in single- vs dual-coil ICD lead implantation and differences in clinical outcomes.

Methods: We evaluated 129,520 ICD recipients enrolled in the LATITUDE remote monitoring system between 2004 and 2014. Kaplan-Meier analyses and Cox proportional hazards regression analyses were used for univariate and multivariate survival analysis, respectively.

Results: The majority of ICD recipients received a dual-coil lead (n = 110,330 [85.2%]). Single-coil lead implantation increased from 1.9% to 55.2% between 2004 and 2014. After adjusting for age, sex, device type, and year of implant, single-coil lead implantation was associated with a greater odds of induction for defibrillation testing (odds ratio 1.05; 95% confidence interval [CI] 1.01-1.09; P = .0274), a higher rate of lead being taken out of service (hazard ratio 1.19; 95% CI 1.06-1.33; P = .0032), and a decreased mortality rate (hazard ratio 0.91; 95% CI 0.87-0.96; P = .0004). In a 795 patient subset with adjudicated shock outcomes, first shock success was no different (87.0% in single coil vs 86.1% in dual coil; P = .8473).

Conclusion: In a large real-world US population, single-coil lead implantation rates increased substantially between 2004 and 2014. Single-coil lead implantation was associated with more frequent defibrillation testing and the lead being taken out of service, but was not associated with increased mortality or more frequent defibrillation failure.

Keywords: Cardiac resynchronization therapy; Dual coil; Implantable cardioverter-defibrillator; Lead; Mortality; Shock; Single coil.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / mortality
  • Arrhythmias, Cardiac / therapy*
  • Defibrillators, Implantable / adverse effects
  • Defibrillators, Implantable / statistics & numerical data*
  • Electrodes, Implanted / adverse effects
  • Electrodes, Implanted / statistics & numerical data*
  • Equipment Design / instrumentation*
  • Equipment Design / methods
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Proportional Hazards Models
  • Shock / epidemiology
  • Shock / etiology
  • Shock / prevention & control
  • Survival Analysis*
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology