The researchers, led by Dr. Pamela Peterson, assistant professor and cardiologist at the Denver (Colo.) Health Medical Center, also conclude that “dual-chamber devices do not appear to offer any clinical benefit over single-chamber devices with regard to death, all-cause readmission, or heart failure readmission in the year following implant.”
For a dual-chamber ICD, leads are attached to the right atrium and the right ventricle. The complexity and duration of the procedure can lead to infection or the need for another operation to address lead displacement.
“There's not an established benefit of a dual-chamber device over a single-chamber device,” Peterson said.
The JAMA study looked at roughly 32,000 Medicare beneficiaries who received an ICD from 2006 to 2009 and did not have an indication for a pacemaker. About 62% received a dual-chamber ICD, while 38% had a single-chamber device implanted. Those patients who had received dual-chamber ICDs reported higher unadjusted rates of complications.
There wasn't a significant difference between mortality, all-cause hospitalizations or heart-failure hospitalizations after one year between the two devices.
A previous study, published in the Journal of the American College of Cardiology in 2011, had similar findings. It found that dual-chamber ICD use was common and that implantation of those devices was tied to increases in periprocedural complications and in-hospital mortality.
The CMS reimburses around $40,000 per ICD, which does not include the cost of hospital stays. This makes ICD implantation one of the highest-paying procedures for hospitals. Dual-chamber ICDs are generally more expensive than single-chamber ICDs, although Peterson said she had not been able to pin down the price differences.
“Dual-chamber devices are more costly for the initial implant and are associated with an increased risk of complications and have a greater risk of generator depletion, both of which have associated costs,” the JAMA study's authors wrote.
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