Dual-Chamber ICDs for Primary Prevention: Pain with No Gain?

Over the past 10 years, randomized, controlled trials have generated relatively good indication criteria for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death. However, strong evidence to inform the choice between a single- and a dual-chamber ICD is much harder to find.

To compare the risks and benefits of single- and dual-chamber ICDs in a real-world primary-prevention population, investigators studied data from the National Cardiovascular Data Registry on Medicare-eligible patients with no documented indication for pacing. Of 32,034 participants, 38% received a single-chamber ICD and 62% received a dual-chamber ICD. In a propensity-matched cohort, the rate of implant-related complications in dual…