Dual-chamber ICDs: How Effective and Safe Are They in the Treatment of Atrial Tachyarrhythmias?

摘要

The rapid development of internal cardioverter defibrillator (ICD) technology in the late 1990s resulted in the construction of sophisticated dual-chamber devices. Initially, the rationale behind their introduction was the possibility of sequential pacing for bradyarrhythmia whenever required, thus avoiding the need for parallel pacemaker implantation. At the same time, the use of an atrial lead was viewed as an opportunity to improve discrimination between supraventricular and ventricular arrhythmias. The experience obtained with atrial defibrillators and in studies on pacing prevention of atrial fibrillation was subsequently also exploited in novel ICD devices. Now, as they have such a powerful tool available, some clinicians suggest the use of dual-chamber devices in all ICD candidates who are in sinus rhythm [1]. Indeed, most ICDs currently implanted in the USA are dual-chamber devices [2]. On the other hand, there is mounting evidence that such an approach is not devoid of risk. Therefore, the purpose of this review is to discuss the pros and cons of dual-chamber ICDs.