Comparative efficacy of single-coil versus dual-coil ICD leads: a meta-analysis of clinical outcomes.

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) are essential for reducing sudden cardiac death in patients at risk of ventricular arrhythmias. The choice of ICD lead - single-coil or dual-coil - can influence device performance and patient outcomes. This meta-analysis evaluates the comparative efficacy and safety of single-coil versus dual-coil ICD leads to inform clinical decision-making.

Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar was performed up to October 2024. Only randomized controlled trials (RCTs) comparing single-coil and dual-coil ICD leads were included. Outcomes assessed included defibrillation threshold (DFT), first-shock efficacy, all-cause mortality, cardiovascular mortality, shock impedance, and peak current.

Results: Seven RCTs involving 1,614 patients were analyzed. Single-coil leads demonstrated superior first-shock efficacy (OR: 1.60; p = 0.05), reduced all-cause mortality (RR: 0.63; p = 0.02), and better peak current (MD: -2.29; p = 0.02). DFT and cardiovascular mortality were comparable between groups, while dual-coil leads exhibited lower shock impedance (MD: 18.26; p < 0.00001).

Conclusions: Single-coil ICD leads are associated with improved first-shock efficacy and reduced all-cause mortality, suggesting their potential superiority in certain patient populations. Further research is warranted to refine lead selection criteria.