Selecting dual chamber or single chamber implantable defibrillators: what is the golden rule?
Santini, Massimo and Ricci, Renato (2003) Selecting dual chamber or single chamber implantable defibrillators: what is the golden rule? Indian Pacing and Electrophysiology Journal, 3 (4). pp. 261-267. ISSN 0972-6292
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During the last years, the implantation rate of dual chamber defibrillators (ICD) significantly increased worldwide. In 1999, the proportion of dual chamber ICD implants reached 30% in Europe and 50% in U.S.A.1. According to manufacturer data, in Italy, the ratio between implanted single chamber and dual chamber units decreased from 1.97 in 1999 to 1.86 in 2000 and 1.50 in 2001. Technological progress, demonstration of reliability and clinical efficacy of the new devices, combined with their smaller size, contributed to their wide acceptance. Nowadays, the matter to be debated is if all the patients in whom the atrium can be sensed and paced should receive a dual chamber ICD or if device selection should be individually evaluated according to different clinical profiles. As a matter of fact, criteria to identify the patients who may benefit more from dual chamber ICD have not been already defined. The theoretical advantages of dual chamber ICD include: improved discrimination between supraventricular and ventricular tachycardias, optimal treatment of symptomatic bradycardias (pre-existing, drug-induced or late developing), hemodynamic and antiarrhythmic benefits.
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