Cost advantage of different cardioverter-defibrillator devices. Jun 22.

摘要

Among patients without a bradycardia indication for pacing, the presumed benefits of routine dual- versus single-chamber implantablecardioverter-defibrillator (ICD) usage, including a potential reduction in inappropriate shocks by enhancement of supraventriculartachycardia detection, remain unproven. Adding to the list of soft reasons for routine dual-chamber device usage is the recent study in JACC by Goldberger et al. (2), who analyzed the financial costs associated with a strategy of universal dual-chamber ICD placement versus implantation of a single-chamber ICD followed by upgrade as clinically indicated. That analysis suggests that even with upgrade rates as low as 5%, a universal dual-chamber implant approach could be the most cost-effective. However, the analysis could not consider two costs, which, though not monetary, are of primary importance.First, the addition of implanting an atrial lead is associated, not surprisingly, with at least a doubling of device and lead-related complication rates. This price would be paid by our patients directly should a universal dual-chamber implant approach be taken.