Battery longevity in cardiac resynchronization therapy implantable cardioverter defibrillators

Alam, Mian Bilal; Munir, Muhammad Bilal; Rattan, Rishi; Flanigan, Susan; Adelstein, Evan; Jain, Sandeep; Saba, Samir

doi:10.1093/europace/eut301

Cited by 42 publications

(41 citation statements)

References 13 publications

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“…This may be due to the need for nearly 100% biventricular pacing in CRT-D devices. The device longevity is known to differ according to the manufacturer [6], and Alam et al reported that the Medtronic CRT-Ds have a shorter battery longevity than the other manufactures [7]. We observed a similar tendency in our CRT-D cohort that Medtronic devices had a shorter survival than the Boston Scientific devices, but it was not statistically significant, possibly due to the small number of patients.…”

Section: Discussionsupporting

confidence: 65%

Risk factors for early replacement of cardiovascular implantable electronic devices

Aizawa¹,

Kunitomi²,

Nakajima³

et al. 2015

International Journal of Cardiology

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Section: Discussionsupporting

confidence: 65%

Risk factors for early replacement of cardiovascular implantable electronic devices

Aizawa¹,

Kunitomi²,

Nakajima³

et al. 2015

International Journal of Cardiology

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“…1 A computational analysis from a US Department of Veterans Affairs database of implants from 1992 to 2007 suggested that the number of device replacements would have decreased by 57% and 75% if the batteries had lasted 7 or 9 years, respectively. 14 Compared with the devices analyzed in this study, the latest generations of devices and battery technology have demonstrated improved longevity, 15 which may reduce the risk of GE‐related complications for patients who survive long enough to require multiple replacements.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Defibrillator Shocks After Elective Generator Exchange Following Uneventful First Battery Life

Merchant

Jones

Wehrenberg

et al. 2014

JAHA

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BackgroundA significant number of implantable cardioverter‐defibrillator (ICD) patients do not experience shocks after ICD implant. Elective generator exchange (GE) has been associated with increased risk of infection and ICD lead failure. There is a paucity of contemporary data reporting on shock incidence with replacement devices.Methods and ResultsPatients undergoing elective GE (n=24 203) who transmit data remotely via a remote monitoring system were analyzed to determine the incidence of ICD shocks after GE. A total of 16 230 patients (67%) did not experience a shock with the first ICD (group A), and 7973 (33%) received at least 1 shock (group B). Patients in group A were older (71.3 versus 68.8 years, P<0.001) and more often female (71% versus 77% male, P<0.001). Over an average follow‐up of 1.9±1.2 years after GE, the proportion of patients with shocks and risk of ICD shocks was lower for those who did not receive a shock during the first battery life (group A: 9.9% versus 27.7%, hazard ratio 0.36, 95% CI 0.34 to 0.38, P<0.001). The cumulative rate of ICD shocks at 5 years after GE was 25.7% in group A and 51.1% in group B.ConclusionsIn this large cohort of ICD patients implanted across the United States, two thirds did not receive ICD shock therapy prior to GE. The occurrence of ICD shocks prior to GE is an important predictor of shocks after GE; however, even among those without shocks during first battery life, the incidence of shocks at 5 years following GE is >25%. These data should support informed decision making for patients and physicians at the time of ICD generator end of service.

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“…Between 2008 and 2014 several studies had been published on the problem of ICD longevity in clinical scenarios. These analyses included ''older'' and currently used ICD devices [9][10][11][12][13][14][15]. In the study by Biffi et al [9] 153 ICD replacements of three different brands were analyzed.…”

Section: Icd Device Technologymentioning

confidence: 99%

“…The three studies by Thijssen, Horlbeck, and Alam [12][13][14] were published after 2012 but included ICD implantations and follow-up over differently long time spans. Thijssen and coworkers [12] reported on 1072 device replacements for battery depletion, performed between 1996 and 2010.…”

Section: Icd Device Technologymentioning

confidence: 99%

“…Regarding devices implanted prior to and after 2002, there was only a small prolongation in service life of less than 10 %. The most recently published study by Alam and coworkers [14] investigated the service life of 646 CRT-D devices of three different manufacturers implanted between 2008 and 2010. Significant differences in device service life among the manufacturers were noted.…”

Section: Icd Device Technologymentioning

confidence: 99%

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The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries

Neuzner

2015

Clin Res Cardiol

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In 2005, Bob Hauser published a paper in the Journal of the American College of Cardiology entitled "The growing mismatch between patient longevity and the service life of Implantable Cardioverter-Defibrillators". Now, nearly a decade later, I would like to perform a second look on the problem of a mismatching between ICD device service life and the survival of ICD recipients. Since 2005, the demographics of the ICD population has changed significantly. Primary prevention has become the dominant indication in defibrillator therapy and device implantation is indicated more and more in earlier stages of cardiac diseases. In former larger scale ICD trials, the patient average 5-year survival probability was in a range of 68-71%; in newer CRT-D trials in a range of 72-88%. Due to a progressively widened ICD indication and implantation preferentially performed in patients with better life expectancy, the problem of inadequate device service life is of growing importance. The early days of defibrillator therapy started with a generator volume of 145 ccm and a device service life <18 months. In this early period, the device miniaturization and extension of service life were similar challenges for the technicians. Today, we have reached a formerly unexpected extent of device miniaturization. However, technologic improvements were often preferentially translated in further device miniaturization and not in prolonging device service life. In his analysis, Bob Hauser reported a prolonged device service life of 2.3 years in ICD models with a larger battery capacity of 0.54 up to 0.69 Ah. Between 2008 and 2014, several studies had been published on the problem of ICD longevity in clinical scenarios. These analyses included "older" and currently used single chamber, dual chamber and CRT devices. The reported average 5-year device service life ranged from 0 to 75%. Assuming today technology, larger battery capacities will only result in minimal increase in device volume. Selected ICD patients may further benefit from device miniaturization-but the vast majority may much more benefit from a significant prolongation in device service life. All published cost-effectiveness analyses in ICD therapy show that device costs and device service life are the dominant determinants of the results. The performed "second look-nearly a decade later" revealed that there are still relevant limitations regarding the device service life in current defibrillator therapy. Technical improvements were preferentially transformed into device miniaturization but not into prolonging device service life. But this optimization is strongly enforced. The most feasible solution might be the use of device batteries with larger capacities. The economic burden, mainly caused by non-adequate device service life, may limit the future realization of ICD therapy in a progressively growing patient population. In the former years, physicians and device manufacturers have ignored the patient perspective in defibrillator therapy. However, it is the patient viewpoint that...

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Battery longevity in cardiac resynchronization therapy implantable cardioverter defibrillators

Abstract: There are significant discrepancies in CRT-ICD battery longevity by manufacturer. These data have important implications on clinical practice and patient outcomes.

Cited by 42 publications

References 13 publications

Risk factors for early replacement of cardiovascular implantable electronic devices

Risk factors for early replacement of cardiovascular implantable electronic devices

Incidence of Defibrillator Shocks After Elective Generator Exchange Following Uneventful First Battery Life

The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries

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