Abstract
The preferred use of dual-coil implantable defibrillator lead systems in current implantable defibrillator therapy is likely based on data showing statistically lower defibrillation thresholds with dual-coil defibrillator lead systems. The following review will summarize the clinical data for dual- versus single-coil defibrillator leads in the left and right pectoral implant locations, and will then discuss the clinical implications of single- versus dual-coil usage for atrial defibrillation, venous complications, and the risks associated with lead extraction. It will be noted that there are no comparative clinical studies on the use and outcomes of single- versus dual-coil lead systems in implantable defibrillator therapy over a long-term follow-up. The limited long-term reliability of defibrillator leads is a major concern in implantable defibrillator and cardiac resynchronization therapy. A simpler single-coil defibrillator lead system may improve the long-term performance of implanted leads. Furthermore, the superior vena cava coil is suspected to increase interventional risk in transvenous lead extraction. Therefore, the need for objective data on extractions and complications will be emphasized.
Similar content being viewed by others
References
Gradaus R, Breithardt G, Böcker D (2002) ICD leads: design and chronic dysfunctions. Pacing Clin Electrophysiol 26:649–657
Haqqani HM, Mond HG (2009) The implantable cardioverter–defibrillator lead: principles, progress, and promises. Pacing Clin Electrophysiol 32:1336–1353
Maisel WH (2007) Transvenous implantable cardioverter–defibrillator leads. The weakest link. Circulation 115:2461–2463
Maisel WH, Kramer DB (2008) Implantable cardioverter–defibrillator lead performance. Circulation 117(2721):2723
Eckstein J, Koller MT, Zabel M, Kalusche D, Schaer BA, Osswald S, Sticherling C (2008) Necessity for surgical revision of defibrillator leads implanted long-term. Causes and management. Circulation 117:2727–2733
Hauck M, Bauer A, Voss F, Weretka S, Katus HA, Becker R (2009) “Home monitoring” for early detection of implantable cardioverter–defibrillator failure: a single-center prospective observational study. Clin Res Cardiol 98:19–24
Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, Saggau W, Weisse U, Seidl K (2007) Annual rate of transvenous defibrillation lead defects in implantable cardioverter–defibrillators over a period of >10 years. Circulation 115:2474–2480
Boriani G, Biffi M, Marziali A, Diemberger I, Martignani C (2009) A changing scenario in the clinical use of implantable defibrillators: the need for long-term data on lead performance. Europace 11:1–3
Goette A, Cantu F, van Erven L, Geelen P, Halimi F, Merino JL, Morgan JM et al (2009) Performance and survival of transvenous defibrillation leads: need for a European data registry. Europace 11:31–34
Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS et al (2008) ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol 21:e1–e62
Hauser RG, Hayes DL (2009) Increasing hazard of Sprint Fidelis implantable cardioverter–defibrillator lead failure. Heart Rhythm 6:605–610
Ellis CR, Rottman JN (2009) Increased rate of subacute lead complications with small-caliber implantable cardioverter–defibrillator leads. Heart Rhythm 6:619–624
2010 Product performance reports. Boston Scientific, Inc.; Medtronic, Inc.; St. Jude Medical, Inc
Gadler F (2009) Swedish pacemaker registry 2009. Available at http://www.pacemakerregistret.se/icdpmr/annualReport/2009/annualReport_2009_1.pdf
Bardy GH, Johnson G, Poole JE, Dolack L, Kudenchuk PJ, Kelso D, Mitchel R, Mehra R, Hofer B (1993) A simplified, single-lead unipolar transvenous cardioversion–defibrillation system. Circulation 88:543–547
Bardy GH, Yee R, Jung W (1996) Multicenter experience with a pectoral unipolar implantable cardioverter-defibrillator. Active Can Investigators. J Am Coll Cardiol 28:400–410
Knuefermann P, Wolpert C, Spehl S, Korte T, Manz M, Lüderitz B, Jung W (2000) Implantable cardioverter/defibrillator: long-term stability of the defibrillation threshold with a unipolar electrode configuration (active can). Z Kardiol 89:774–780
Poole JE, Bardy GH, Kudenchuk PJ, Dolack GL, Raitt MH, Mehra R, Johnson G (1995) Prospective randomized comparison of biphasic waveform tilt using a unipolar defibrillation system. Pacing Clin Electrophysiol 18:1369–1373
Gold MR, Foster AH, Shorofsky SR (1997) Lead system optimization for transvenous defibrillation. Am J Cardiol 80:1163–1167
Gold MR, Olsovsky MR, Pelini MA, Peters RW, Shorofsky SR (1998) Comparison of single- and dual-coil active pectoral defibrillation lead systems. J Am Coll Cardiol 31:1391–1394
Gold MR, Olsovsky MR, DeGroot PJ, Cuello C, Shorofsky SR (2000) Optimization of transvenous coil position for active can defibrillation thresholds. J Cardiovasc Electrophysiol 11:25–29
Lubinski A, Lewicka-Nowak E, Zienciuk A, Krolak T, Kempa M, Pazdyga A, Raczak C, Swiatecka G (2005) Comparison of defibrillation efficacy using implantable cardioverter–defibrillator with single- or dual-coil defibrillation leads and active can. Kardiol Pol 63:234–241
Gold M, Val-Mejias J, Lennan RB, Tummala R, Goyal S, Kluger J et al (2008) Optimization of superior vena cava coil position and usage for transvenous defibrillation. Heart Rhythm 5:394–399
Bardy GH, Dolack L, Kudenchuk PJ, Poole JE, Mehra R, Johnson G (1994) Prospective, randomized comparison in humans of a unipolar defibrillation system with that using an additional superior vena cava electrode. Circulation 89:1090–1093
Manolis AS, Chiladakis J, Maounis TN, Vassilikos V, Cokkinos DV (2000) Two-coil versus single-coil transvenous cardioverter defibrillator systems: comparative data. Pacing Clin Electrophysiol 23:1999–2002
Schulte B, Sperzel J, Carlsson J, Schwarz T, Ehrlich W, Pitschner HF, Neuzner J (2001) Dual-coil versus single-coil active pectoral implantable defibrillator lead systems: defibrillation energy requirements and probability of defibrillation success at multiples of the defibrillation energy requirements. Europace 3:177–180
Rinaldi CA, Simon RDB, Geelen P, Reek P, Baszko A, Kuehl M, Gill JS (2003) A randomized prospective study of single-coil versus dual-coil defibrillation in patients with ventricular arrhythmias undergoing implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol 26:1684–1690
Rüb N, Schweitzer O, Mewis C, Kettering K, Kuehlkamp V (2004) Addition of a defibrillation electrode in the low right atrium to a right ventricular lead does not reduce ventricular defibrillation thresholds. Pacing Clin Electrophysiol 27:346–351
Carlsson J, Schulte B, Erdogan A, Sperzel J, Güttler N, Schwarz T, Pitschner HF, Neuzner J (2003) Prospective randomized comparison of two defibrillation safety margins in unipolar, active pectoral defibrillation therapy. Pacing Clin Electrophysiol 26:613–618
Gold MR, Higgins S, Klein R, Gilliam R, Kopelman H, Hessen S, Payne J, Strickberger SA, Breiter D, Hahn S (2002) Efficacy and temporal stability of reduced safety margins for ventricular defibrillation. Primary results from the Low Energy Safety Study (LESS). Circulation 105:2043–2048
Val-Mejias JE, Oza A (2010) Does defibrillation threshold increase as left ventricular ejection fraction decreases? Europace 12:385–388
Morgan JM, Marinskis G (2011) Defibrillation testing at the time of implantable cardioverter defibrillator implantation: results of the European Heart Rhythm Association survey. Europace 13:581–582
Brigniole M, Raciti G, Bongiorni MG, Da Martine G, Favale S, Gasparini M, Luise R, Ochetta E, Prolemer A (2007) Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey. Europace 9:540–543
Healey JS, Dorian P, Mitchell LB, Talajic M, Philioppon F, Simpson C, Yee R, Morillo CA, Lamy A, Basta M, Birnie DH, Wang X, Nair GM, Crystal E, Kerr CR, Connolly SJ (1010) Canadian Registry of ICD Implant Testing procedures (CREDIT): current practice, risks, and costs of intraoperative defibrillation testing. J Cardiovasc Electrophysiol 2:177–182
Swerdlow CD, Russo AM, Degroot PJ (2007) The dilemma of ICD implant testing. Pace Clin Electrophysiol 30:675–700
Shockless Implant Evaluation “SIPMLE” Study; Clinical Trials.gov Identifier: NCT00800384
Russo AM, Sauer W, Gerstenfeld EP, Hsia HH, Lin D, Cooper JM, Dixit S, Verdino RJ, Nayak HM, Callans DJ, Patel V, Marchlinski FE (2005) Defibrillation threshold testing: is it really necessary at the time of implantable cardioverter–defibrillator insertion? Heart Rhythm 5:456–461
Varma N, Efimov I (2008) Right pectoral implantable cardioverter defibrillators: role of the proximal (SVC) coil. Pacing Clin Electrophysiol 31:1025–1035
Epstein AE, Kay N, Plumb VJ, Voshage-Stahl L, Hull ML, for the Endotak investigators (1995) Elevated defibrillation thresholds when right sided venous access is used for nonthoracotomy implantable defibrillator lead implantation. J Cardiovasc Electrophysiol 6:979–986
Friedman PA, Rasmussen MJ, Grice S, Trusty J, Glikson M, Stanton MS (1999) Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators. Pacing Clin Electrophysiol 22:1186–1192
Gold MR, Shih HT, Herre J, Breiter D, Zhang Y, Schwarz M, for the Low Energy Safety Study Investigators (2007) Comparison of defibrillation efficacy and survival associated with right versus left pectoral placement for implantable defibrillators. Am J Cardiol 100:243–246
Flaker GC, Tummala R, Wilson J (1998) Comparison of right- and left-sided pectoral implantation parameters with the Jewel Active Can cardiodefibrillator. The World Wide Jewel Investigators. Pacing Clin Electrophysiol 21:447–451
Natale A, Sra J, Geiger MJ, Newby K, Akhtar M, Pacifico A (1997) Right side implant of the unipolar single lead defibrillation system. Pacing Clin Electrophysiol 20:1910–1912
Keane D, Aweh N, Hynes B, Sheahan RG, Cripps T, Bashir Y et al (2007) Achieving sufficient safety margins with fixed duration waveforms and the use of multiple time constants. Pacing Clin Electrophysiol 30:596–602
Swerdlow CD, Fan W, Brewer JE (1996) Charge-burping theory correctly predicts optimal ratios of phase duration for biphasic defibrillation waveforms. Circulation 94:2278–2284
Irnich W (2010) From defibrillation theory to clinical implications. Pacing Clin Electrophysiol 33:814–825
Kroll MW, Schwab JO (2010) Acieving low defibrillation thresholds at implant: pharmacological influences, RV-coil polarity and position, SVC coil usage and positioning, pulse width settings, and the azygous vein. Fundam Clin Pharmacol 24:561–573
Stajduhar KC, Ott GY, Kron J, McAnulty JH, Oliver RP, Reynolds BT, Adler SW, Halperin BD (1996) Optimal electrode position for transvenous defibrillation: a prospective randomized study. J Am Coll Cardiol 27:90–94
Winter J, Heil JE, Schumann C, Lin Y, Schannwell CM, Michel U, Schipke JD, Schulte HD, Gams E (1998) Effect of implantable cardioverter/defibrillator lead placement in the right ventricle on defibrillation energy requirements. A combined experimental and clinical study. Eur J Cardiothorac Surg 14:419–425
Rashaba EJ, Bonner M, Wilson J, Shorofski SR, Peters RW, Gold MR (2003) Distal right ventricular coil position reduces defibrillation thresholds. J Cardiovasc Electrophysiol 14:1036–1040
Rashaba EJ, Shorofsky SR, Peters RW, Gold MR (2004) Optimization of atrial defibrillation with dual-coil, active pectoral lead system. J Cardiovasc Electrophysiol 15:790–794
Cooklin M, Olsovsky MR, Brockmann RG, Shorofsky SR, Gold MR (1999) Atrial defibrillation with a transvenous lead: a randomized comparison of active can shocking pathways. J Am Coll Cardiol 34:358–362
Rashaba EJ, Shorofski SR, Brown T, Peters RW, Gold MR (2005) Clinical predictors of atrial defrillation thresholds with a dual-coil, active pectoral lead system. Heart Rhythm 2:49–54
Rozmus G, Daubert JP, Huang DT, Rosero S, Hall B, Francis C (2005) Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol 13:9–19
Lickfett L, Bitzen A, Arepally A, Nasir K, Wolpert C, Jeong KM, Krause W, Schimpf R, Lewalter T, Calcins H, Jung W, Lüderitz B (2004) Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace 6:25–31
Parkash R, Crystal E, Bashir J, Simpson C, Birnie D, Sterns L, Exner D (2010) Complications associated with revision of Sprint Fidelis leads: report from the Canadian Heart Rhythm Society Device Advisory Committee. Circulation 121:2384–2387
Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Camillo RG, Crossley GH 3rd et al (2009) Transvenous lead extraction: heart rhythm society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 6:1085–1094
Kennergren C, Bjurman C, Wiklund R, Gäbel J (2009) A single-centre experience of over one thousand lead extractions. Europace 11:612–617
Bracke FALE, Meijer A, van Gelder LM (2002) Malfunction of endocardial defibrillator leads and lead extraction: where do they meet? Europace 4:19–24
Malecka B, Kutarski A, Grabowski M (2010) Is the transvenous extraction of cardioverter–defibrillator leads more hazardous than of pacemaker leads. Kardiol Pol 68:884–890
Cooper JM, Stephenson EA, Berul CI, Walsh EP, Epstein LM (2003) Implantable cardioverter defibrillator lead complications and laser extraction in children and young adults with congenital heart disease: implications for implantation and management. J Cardiovasc Electrophysiol 14:344–349
Di Cori A, Bongiorni MG, Zucchelli G, Segreti L, Viani S, Paperini L, Soldati E (2010) Transvenous extraction performance of expanded polytetrafluoroethylene covered ICD leads in comparison to traditional ICD leads in humans. Pacing Clin Electrophysiol 33:1376–1381
Smith MC, Love CJ (2008) Extraction of transvenous pacing and ICD leads. Pacing Clin Electrophysiol 31:736–752
Hauser RG, Katsiyiannis WT, Gornick CC, Almquist AK, Kallinen LM (2010) Deaths and cardiovascular injuries due to device-assisted implantable cardioverter–defibrillator and pacemaker lead extraction. Europace 12:395–401
Farooqi FM, Talsania S, Hamid S, Rinaldi CA (2010) Extraction of cardiac rhythm devices: indications, techniques and outcomes for the removal of pacemaker and defibrillator leads. Int J Clin Pract 64:1140–1147
Bracke F (2008) Complications and lead extraction in cardiac pacing and defibrillation. Neth Heart J 16(Suppl 1):S28–S31
Kennergren C, Bucknall CA, Butter C, Charles R, Fuhrer J, Grosfeld M et al (2007) Laser-assisted lead extraction: the European experience. Europace 9:651–656
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Neuzner, J., Carlsson, J. Dual- versus single-coil implantable defibrillator leads: review of the literature. Clin Res Cardiol 101, 239–245 (2012). https://doi.org/10.1007/s00392-011-0407-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-011-0407-z