RT Journal
A1 Redberg RF, MD, MSc
T1 Dual-chamber implantable cardioverter-defibrillators for nonpacing indications: Comment on “variation in use of dual-chamber implantable cardioverter defibrillators”
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2012
FD April 23
VO 172
IS 8
SP 641
OP 641
DO 10.1001/archinternmed.2012.710
UL http://dx.doi.org/10.1001/archinternmed.2012.710
AB 
Despite the absence of data to support benefit for patients receiving a dual-chamber implantable cardioverter-defibrillator (ICD) compared with a single-chamber ICD for a nonpacing indication, most implants are of dual-chamber ICDs. In contrast to the lack of data for benefit, there are data from multiple randomized and observational trials suggesting increased harm. A recent National Cardiovascular Data Registry (NCDR) analysis found that procedural complications, including in-hospital mortality, were at least 40% greater for dual-chamber compared with single-chamber devices. In this issue, in an analysis of NCDR data from 2006 to 2009, Matlock et al found wide geographic variation with a 4-fold difference in the chance of receiving dual-chamber ICDs. This varied and widespread use of dual-chamber devices for nonpacing indications has no known benefit and definite harms, and is designated as Less Is More.