Inappropriate ICD Discharges in Single-chamber Versus Dual-chamber Devices in the Pediatric and Young Adult Population

Background: Implantable cardioverter defibrillator (ICD) use is increasing in young patients and is frequently complicated by inappropriate device discharges (IDs), leading to discomfort, anxiety and, potentially, proarrhythmia. Dual-chamber (DC) ICDs may decrease IDs by improving rhythm discrimination, but are associated with increased size, expense, and implant complications. We examined whether the frequency of IDs was the same in dual- and single-chamber (SC) ICDs in young patients.

Methods: A multicenter review of patients <or=30 years of age with ICDs was performed. Demographic data and number of appropriate discharges (ADs) and IDs were collected. ADs and IDs were categorized after review of the episode by the primary electrophysiologist.

Results: Of 168 subjects (SC = 52; female = 76), 41 patients received 139 ADs, while 35 patients received 159 IDs. There were no differences related to gender or primary diagnosis, but patients with SC versus DC devices were younger (12.3 +/- 5.0 years vs 14.9 +/- 4.4 years, P < 0.0001) at implant. SC and DC devices were implanted with the same frequency for primary and secondary prevention. There were no significant differences in the incidence of IDs or ADs between the patients with SC or DC devices (AD: 12/52 SC vs 29/116 DC, P = 0.79; ID 7/52 SC vs 28/116 DC, P = 0.13).

Conclusion: In this cohort of young patients, DC ICDs did not provide added protection from IDs. Hence, the added complexity and cost of an atrial lead appear unwarranted if used solely for assistance with rhythm discrimination in young patients.