Technologies for Prolonging Cardiac Implantable Electronic Device Longevity

Lau, Ernest W.

doi:10.1111/pace.12989

Cited by 26 publications

(18 citation statements)

References 73 publications

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“…In addition, battery depletion remains the most common reason for device reoperation, with at least a 4.0% risk of major complications . CIED features and programming have become increasingly complex through time for a variety of reasons, with the most energy‐intensive features including radiofrequency telemetry, cardiac resynchronization therapy (CRT) pacing, and defibrillation . Despite an increase in the numbers and types of energy‐intensive processes running on modern CIEDs, device longevity continues to improve, with the Boston Scientific (Marlborough, MA, USA) 2.0Ah EnduraLife TM Battery Technology powering the longest‐lasting implantable cardioverter‐defibrillator (ICD) generators in the industry across multiple studies …”

Section: Introductionmentioning

confidence: 99%

Premature battery depletion due to compromised low‐voltage capacitor in a family of defibrillators

Montgomery

Sensing²,

Saunders³

et al. 2019

Pacing Clinical Electrophis

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Background: Boston Scientific (Marlborough, MA, USA) implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) manufactured between 2008 and 2014 are potentially subject to premature battery depletion through a low-voltage capacitor malfunction occurring as a result of hydrogen buildup within the device. Although some of these devices are currently under advisory, other devices manufactured during this timeframe carry a lower risk of the same malfunction. These same devices are known to have superior longevity in general, and the overall mean lifespan of the devices remains long.Methods: All patients implanted or followed at our two centers who experienced premature battery depletion and had a Boston Scientific ICD or CRT-D potentially at risk for low-voltage capacitor malfunction were studied retrospectively.Results: Nineteen out of 838 patients (2.3%) with devices potentially at risk have had premature battery depletion: 5.7% of those under advisory and 1.1% of those not under advisory. None of our patients had compromised therapy, and all had >27 days of projected battery longevity remaining. Conclusions:Undetected premature battery depletion in this population of ICDs has the potential to expose a patient to an interval of time where the device is unable to provide therapy. However, with enrollment in remote monitoring, regular follow-up, and attention to audible alerts, the risk of therapy loss due to low-voltage state can be effectively mitigated. For these reasons, prophylactic generator replacement is not recommended. K E Y W O R D Sbattery failure, generator change, high-voltage capacitor, implantable cardioverter-defibrillator, low-voltage capacitor, premature battery depletion

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Section: Introductionmentioning

confidence: 99%

Premature battery depletion due to compromised low‐voltage capacitor in a family of defibrillators

Montgomery

Sensing²,

Saunders³

et al. 2019

Pacing Clinical Electrophis

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“…For the Viva Quad XT, the only source of longevity data available to the study was its manual. Based on a previous publication, pacing appears to be powered by LR with transition at

V_{p}

= 2.5, 3.5, 5, 7.5, and 8 V. Assuming internal resistance

α_{p}

= 100 Ω, pacing capacitance

C_{p}

= 0.01 mF, and pacing energy efficiency

η_{p}

= 0.85 for all channels, the total pacing power P 1 according to the settings in its manual was calculated (see Appendix ). The

1 / t^{\circ}

– P 1 plot comprises two lines with the same

1 / t^{\circ}

intercept but different slopes (ratio 1.08; LV amplitude = 4 V for all the points on the less steep line; Figure A).…”

Section: Resultsmentioning

confidence: 99%

“…The shock energy efficiency of 0.45 is not necessarily due to bad engineering, but may reflect a conscious decision to maximize power transfer (shorten charge time) during shock therapy. By the maximum power theorem, power transfer from a battery is maximum when energy efficiency is 0.5 …”

Section: Discussionmentioning

confidence: 99%

“…For Biotronik (Btk, Berlin, Germany), the Intica 7 HF‐T (QP) was chosen (data: manual). For Medtronic (Mdt, Minneapolis, MN, USA), the Viva Quad XT model DTBA1QQ was chosen (data source: manual; a previous publication).…”

Section: Methodsmentioning

confidence: 99%

“…By the maximum power theorem, power transfer from a battery is maximum when energy efficiency is 0.5. 15,16…”

Section: Shock Energy Efficiencymentioning

confidence: 99%

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Longevity decoded: Insights from power consumption analyses into device construction and their clinical implications

Lau

2019

Pacing Clinical Electrophis

Self Cite

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Introduction The longevity of a cardiac implantable electronic device (CIED) depends on how quickly the powers consumed by the device's functions exhaust its usable battery energy. A mathematical model for CIED power consumptions was developed and validated against longevity data from manufacturers. Methods The programmable parameters for the Resonate X4 cardiac resynchronization therapy defibrillators (CRT‐Ds) on the Boston Scientific (St. Paul, MN, USA) online longevity calculator were designated as independent terms in the sum for the total power consumption. The reciprocal of longevity was plotted against variations in these terms. Linear and nonlinear regression analyses were used to fit the plots. The power consumed by pacing was theoretically derived and used as the calibrating tool for estimating the powers consumed by other functions and the usable battery energy. The same methodology was applied to the longevity data of other manufacturers’ CRT‐Ds. Results Single chamber 100% pacing at 60 beats/min, 2.5 V, 0.4 ms, 500 Ω consumes ≈ 144 J/year. Shock therapy is 45–85% energy efficient. Multichamber pacing modes and maintaining readiness to pace a chamber consume power even if no pacing is delivered. Switching voltage regulation is theoretically more energy efficient than linear voltage regulation for powering pacing. Conclusions The powers consumed by therapy functions are dictated by the patient's clinical needs, but healthcare professionals can extend device longevity by switching off dormant functions and simplifying the pacing mode. Choosing a device model with large usable battery energy, low background power, and energy efficient pacing and shock therapy for implantation will increase the probability of a long service lifespan.

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Ultrasound‐Powered Implants: A Critical Review of Piezoelectric Material Selection and Applications

Turner

Senevirathne

Kilgour

et al. 2021

Adv Healthcare Materials

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Ultrasound‐powered implants (UPIs) represent cutting edge power sources for implantable medical devices (IMDs), as their powering strategy allows for extended functional lifetime, decreased size, increased implant depth, and improved biocompatibility. IMDs are limited by their reliance on batteries. While batteries proved a stable power supply, batteries feature relatively large sizes, limited life spans, and toxic material compositions. Accordingly, energy harvesting and wireless power transfer (WPT) strategies are attracting increasing attention by researchers as alternative reliable power sources. Piezoelectric energy scavenging has shown promise for low power applications. However, energy scavenging devices need be located near sources of movement, and the power stream may suffer from occasional interruptions. WPT overcomes such challenges by more stable, on‐demand power to IMDs. Among the various forms of WPT, ultrasound powering offers distinct advantages such as low tissue‐mediated attenuation, a higher approved safe dose (720 mW cm−2), and improved efficiency at smaller device sizes. This study presents and discusses the state‐of‐the‐art in UPIs by reviewing piezoelectric materials and harvesting devices including lead‐based inorganic, lead‐free inorganic, and organic polymers. A comparative discussion is also presented of the functional material properties, architecture, and performance metrics, together with an overview of the applications where UPIs are being deployed.

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Technologies for Prolonging Cardiac Implantable Electronic Device Longevity

Cited by 26 publications

References 73 publications

Premature battery depletion due to compromised low‐voltage capacitor in a family of defibrillators

Premature battery depletion due to compromised low‐voltage capacitor in a family of defibrillators

Longevity decoded: Insights from power consumption analyses into device construction and their clinical implications

Ultrasound‐Powered Implants: A Critical Review of Piezoelectric Material Selection and Applications

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