Author + information
- Zachary Goldberger, MD,
- Craig A. McPherson, MD, FACC and
- Rachel Lampert, MD, FACC⁎ ()
- ↵⁎Yale University School of Medicine, Section of Cardiology, 333 Cedar Street, FMP 3, New Haven, Connecticut 06520
Dr. Veenhuyzen argues that inserting dual-chamber implantable cardioverter-defibrillators (ICDs) in the interest of cost-saving is unethical, because those patients who would not go on to require an upgrade are asked to “shoulder the burden of unnecessary medical procedures” by having the dual-chamber device implanted upfront. This argument rests on the assumption that the risks of atrial lead implantation outweigh the benefits of the dual-chamber device. However, the benefits are likely greater than outlined in Dr. Veenhuyzen’s letter.
As described and referenced in our study (1), although not all studies show improved discrimination between ventricular and supraventricular arrhythmias with the dual-chamber device, most do. Further, even if there were no benefit, the issue of risk is more complicated than that described. There is an increased risk of atrial lead dislodgement with the dual-chamber device (other complications are not different). However, as referenced in our study, there is also an increased risk of infection, a more serious complication, with upgrade. Even if there were no benefit at all, patients might trade an upfront risk of a less-serious complication to avoid the possibility of a more serious risk later on. Thus, we believe that our data show not that a strategy of universal dual-chamber ICD placement would trade clinical good for cost-saving, but rather that the most beneficial approach for the patient is also the least expensive for the health care system.
- American College of Cardiology Foundation