Impact of pacemaker longevity on expected device replacement rates: Results from computer simulations based on a multicenter registry (ESSENTIAL)

Boriani, Giuseppe; Bertini, Matteo; Saporito, Davide; Belotti, Giuseppina; Quartieri, Fabio; Tomasi, Corrado; Pucci, A.; Boggian, Giulio; Mazzocca, Gian Franco; Giorgi, Davide; Diotallevi, P; Sassone, Biagio; Grassini, D; Gargaro, Alessio; Biffi, Mauro

doi:10.1002/clc.23003

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…Moreover, RR pacing and a high resting rate decrease heart rate variability, that is a prognostic marker in HF: blunting the rate‐lowering effects of beta‐blockers is associated to worsening of left ventricular (LV) function . Finally, the increased pacing percentage associated with RR could impact on device longevity, this latter being negatively associated with pacing percentage . Although chronotropic incompetence is frequently encountered in HF patients either as a pharmacological effect of drugs or as β‐receptors down‐regulation, it is rarely associated to symptoms of reduced exercise tolerance, being the relationship of cardiac output with heart rate flattened at a ceiling heart rate of 100‐110 bpm in systolic LV dysfunction .…”

Section: Discussionmentioning

confidence: 99%

“…19 Finally, the increased pacing percentage associated with RR could impact on device longevity, this latter being negatively associated with pacing percentage. 20 Although chronotropic incompetence is frequently encountered in HF patients either as a pharmacological effect of drugs or as β-receptors downregulation, it is rarely associated to symptoms of reduced exercise tolerance, being the relationship of cardiac output with heart rate flattened at a ceiling heart rate of 100-110 bpm in systolic LV dysfunction. 21 These observations make atrial pacing redundant in the majority of CRT recipients, and have prompted the use of two-leads CRT mimicking VDD mode.…”

Section: Rr Pacing In Hfmentioning

confidence: 99%

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Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?

Biffi

D’Onofrio

Pignalberi

et al. 2019

Clinical Cardiology

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Background The role of atrial rate‐responsive (RR) pacing in cardiac resynchronization therapy (CRT) is unclear due to the favorable effect of rate lowering in systolic heart failure. Atrial high rate episodes (AHREs) in CRT recipients are particularly worrisome since they cause loss of CRT, beyond representing a stroke risk factor. Hypothesis The presence of an association between RR and the incidence of AHREs. Methods Daily remote transmissions from 836 CRT recipients were analyzed. AHREs were classified by duration: ≥15 minutes, ≥5 hours, and ≥ 24 hours. Variables possibly associated to AHREs were included in time‐dependent proportional‐hazard models, averaging over 30‐day periods and adjusting for main baseline variables. Results After a median follow‐up of 23.9 (12.2‐36.0) months, 507 (60.6%) patients experienced at least one 15‐minute AHRE. RR function was programmed in 166 (19.8%) patients and was associated with an increased AHRE occurrence rate with hazard ratio (HR) ranging from 1.45 to 1.78 for the 3 cutoffs of episode duration. The negative effect of RR function was not observed in the subset of patients with low mean heart rate (<68 bpm). Higher mean heart rates increased AHRE risk (HR:1.02, P = .01), while CRT amount decreased it (HR:0.98, P < .01). The extent of atrial pacing did not predict AHRE occurrence. Conclusions RR pacing in CRT recipients is associated with increased AHRE occurrence, especially when an average heart rate > 68 bpm is attained.

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Section: Discussionmentioning

confidence: 99%

Section: Rr Pacing In Hfmentioning

confidence: 99%

Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?

Biffi

D’Onofrio

Pignalberi

et al. 2019

Clinical Cardiology

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“…The principle of prophylactic replacement has been used in pacemaker users for years. This has given pacemaker users the security of a continuously working device 10,11 . The device lifetime of pacemakers depends on the battery.…”

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confidence: 99%

Does Prophylactic Replacement of Voice Prosthesis Make Sense? A Study to Predict Prosthesis Lifetime

Heirman

Noort

Son

et al. 2022

Otolaryngol.--head neck surg.

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Objective Voice prosthesis leakage significantly affects the quality of life of patients undergoing laryngectomy, causing insecurity and frequent unplanned hospital visits and costs. In this study, the concept of prophylactic voice prosthesis replacement was explored to prevent leakages. Study Design Retrospective cohort study. Setting Tertiary hospital. Methods This study included all patients who underwent laryngectomy between 2000 and 2012 in the Netherlands Cancer Institute. Device lifetimes and voice prosthesis replacements of a retrospective cohort were used to calculate the number of needed voice prostheses per patient per year to prevent 70% of the leakages by prophylactic replacement. Various strategies for the timing of prophylactic replacement were considered: adaptive strategies based on the individual patient’s history of replacement and fixed strategies based on the results of patients with similar voice prosthesis or treatment characteristics. Results Patients used a median 3.4 voice prostheses per year (range, 0.1-48.1). We found high inter- and intrapatient variability in device lifetime. When prophylactic replacement is applied, this would become a median 9.4 voice prostheses per year, which means replacement every 38 days, implying >6 additional voice prostheses per patient per year. The individual adaptive model showed that preventing 70% of the leakages was impossible for most patients and only a median 25% can be prevented. Monte-Carlo simulations showed that prophylactic replacement is not feasible due to the high coefficient of variation (SD/mean) in device lifetime. Conclusion Based on our simulations, prophylactic replacement of voice prostheses is not feasible due to high inter- and intrapatient variation in device lifetime.

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Implanted Pulse Generators in Lower Extremity Neuroprostheses: A 25-Year Review

Leapo,

Miller,

Hoyen

et al. 2024

Neuromodulation: Technology at the Neural Interface

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Impact of pacemaker longevity on expected device replacement rates: Results from computer simulations based on a multicenter registry (ESSENTIAL)

Cited by 7 publications

References 17 publications

Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?

Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?

Does Prophylactic Replacement of Voice Prosthesis Make Sense? A Study to Predict Prosthesis Lifetime

Implanted Pulse Generators in Lower Extremity Neuroprostheses: A 25-Year Review

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