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
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.