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Single or Dual Coil Defibrillation Leads? Let's Keep it Simple!

Implantation of dual coil implantable cardioverter defibrillator (ICD) leads has been dominant worldwide for almost 2 decades despite the lack of compelling clinical outcomes data supporting this choice.1 This clinical decision has likely been driven by some data from small studies reporting lower defibrillation thresholds (DFTs) when compared with single coil leads, and the tradition has continued despite the evolution of ICD technology including efficient biphasic waveforms, active can systems, and higher voltage outputs.1 However, dual coil leads are more expensive, there is concern of increased risk of lead failure due to the greater number of components in the lead body and recent reports highlight the increased risk of a complication if a dual coil lead requires extraction.1-5 In the present issue of the Journal, Kutyifa et al. compared DFTs at implantation, first shock efficacy, and longterm clinical outcomes in 1,783 patients implanted with dual versus single coil ICD leads who participated in Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT).2 The authors report a modest but statistically significant reduction in DFTs with dual coil leads compared with single coil leads (average 1.8 Joule difference). However, despite this difference, first shock efficacy was similar in both groups (90% and 92% for dual and single coil leads, respectively). Furthermore, survival, shortand long-term complications were similar in both groups. Just recently, the Sudden Cardiac Death in Heart Failure (SCD-HeFT) investigators also reported that DFTs, first shock efficacy, and overall survival were similar in patients receiving a dual or single coil lead.3 Both groups of investigators conclude that there is no benefit of dual coil leads compared with single coil leads and advocate for implantation of single coil leads in most patients. These 2 studies have the limitations of retrospective analyses, the subjects were not randomized to lead selection and a much smaller number of single coil leads were evaluated. In MADIT-CRT, only 10% of patients received a single coil lead and their follow-up duration was shorter compared with