A conservative approach to the complexity of the lead system used with the implanted defibrillator appears prudent. While dual-chamber systems seem attractive since they may reduce inappropriate ICD therapies because of improved ability to discriminate between supraventricular and ventricular arrhythmias, a reduction in the number of implanted leads may be a favorable approach in this relatively young patient group, precisely because of the incidence of lead-related complications over long-term follow-up. There is currently no firm evidence to support the routine use of a dual-chamber defibrillator in ARVC/D. However, for patients with inappropriate sinus node function and preserved atrioventricular conduction, this is a viable option. The potential benefits of such an approach should, however, still be weighed against the long-term complications associated with additional hardware for each individual patient.
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