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de Almeida Fernandes D, António N, Sousa PA, Preto L, Madeira M, Elvas L, Gonçalves L. "Real-world" analysis of battery longevity of implantable cardioverter-defibrillators: an in-depth analysis of a prospective defibrillator database. BMC Cardiovasc Disord 2023; 23:609. [PMID: 38087189 PMCID: PMC10717854 DOI: 10.1186/s12872-023-03653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is a lack of evidence regarding contemporary implantable cardioverter-defibrillator (ICD) battery longevity. Our aim was to assess battery longevity in ICDs in a real-world setting. METHODS Retrospective cross-sectional single center study of a prospectively collected database of consecutive patients who underwent ICD implantation from January 2010 to December 2015. Clinical data and battery longevity of all manufacturers were collected. RESULTS A total of 351 patients (84.6% males, mean age of 61 ± 12 years) were included in the study (292 VVI; 6 VDD; 53 DDD). All manufacturers (Abbott, Biotronik, Boston, Medtronic and Microport) were equally represented in the study (p = 0.110). Median battery longevity was 10.8 years (11 years for VVI and 8.5 for DDD). After a follow-up time of 5 years, 98% of VVI and DDD were still in service (vs. industry-projected longevity of 98%). During this time, 89 patients (25.4%) underwent device replacement - 69 patients (77.5%) due to battery depletion, 6 patients due to infection, 3 patients due to dysfunction and 13 patients due to upgrade to CRT-D. Patients with Medtronic or Biotronik ICDs had a greater probability of being replaced earlier due to battery depletion (Biotronik HR 6.87, 95% CI 2.54-18.58, p < 0.001; Medtronic HR 6.08, 95% CI 2.45-15.06 p < 0.001). CONCLUSIONS VVI and DDD ICD battery longevity matched industry-projected longevity after 5 years of follow-up. Medtronic and Biotronik ICDs appeared to have an earlier battery depletion. Further randomized studies are required to ensure optimal care.
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Affiliation(s)
- Diogo de Almeida Fernandes
- Department of Cardiology, Serviço de Cardiologia, Coimbra Hospital and University Centre (CHUC), Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal.
| | - Natália António
- Department of Cardiology, Serviço de Cardiologia, Coimbra Hospital and University Centre (CHUC), Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Pedro A Sousa
- Department of Cardiology, Serviço de Cardiologia, Coimbra Hospital and University Centre (CHUC), Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Leonor Preto
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Marta Madeira
- Department of Cardiology, Serviço de Cardiologia, Coimbra Hospital and University Centre (CHUC), Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Luís Elvas
- Department of Cardiology, Serviço de Cardiologia, Coimbra Hospital and University Centre (CHUC), Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Serviço de Cardiologia, Coimbra Hospital and University Centre (CHUC), Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, ICBR, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
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Dasgupta S, Mah DY. Lead Management in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:481-491. [PMID: 37865521 DOI: 10.1016/j.ccep.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined by patient size/weight and operator experience. Anatomic considerations, including residual shunts, anatomic obstructions and barriers, and abnormalities in the native conduction system, will affect the type of CIED implanted. Given the young age of patients, it is important to have an "eye on the future" when making pacemaker/defibrillator decisions, as one can expect several generator changes, lead revisions, and potential lead extractions during their lifetime.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, 231 East Chestnut Street, Louisville, KY 40202, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Paton MF, Landolina M, Billuart JR, Field D, Sibley J, Witte K. Projected longevities of cardiac implantable defibrillators: a retrospective analysis over the period 2007–17 and the impact of technological factors in determining longevity. Europace 2020; 22:149-155. [DOI: 10.1093/europace/euz222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Aims
Implanters of cardiac implantable electronic devices cannot easily choose devices by longevity as usually current models only have projected longevity data since those with known performance are obsolete. This study examines how projected device longevities are derived, the influencing factors, and their roles in guiding model choice.
Methods and results
Ninety-eight implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) models released in Europe in 2007–17 were analysed for reported battery capacities, projected longevities for standardized settings stipulated by the French Haute Autorité de Santé (HAS) and manufacturer-chosen settings. Battery capacities and HAS projected longevities increased during the study period. Based on current drain estimation, therapy functions consumed only a small portion (2–7%) of the battery energy for single- and dual-chamber ICDs, but up to 50% (from biventricular pacing) for CRT-Ds. Large differences exist between manufacturers and models both in terms of battery capacity and energy consumption.
Conclusion
Battery capacity is not the sole driver of longevity for electronic implantable cardiac devices and, particularly for ICDs, the core function consume a large part of the battery energy even in the absence of therapy. Providing standardized current drain consumption in addition to battery capacity may provide more meaningful longevity information among implantable electronic cardiac devices.
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Affiliation(s)
- Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | | | - Duncan Field
- Department of Cardiology, Colchester General Hospital, Essex, UK
| | - Jonathan Sibley
- Departemt of Cardiac Physiology, Essex Cardio-thoracic Centre, Basildon, UK
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Poli S, Boriani G, Zecchin M, Facchin D, Gasparini M, Landolina M, Ricci RP, Lanera C, Gregori D, Proclemer A. Favorable Trend of Implantable Cardioverter-Defibrillator Service Life in a Large Single-Nation Population: Insights From 10-Year Analysis of the Italian Implantable Cardioverter-Defibrillator Registry. J Am Heart Assoc 2019; 8:e012759. [PMID: 31340695 PMCID: PMC6761663 DOI: 10.1161/jaha.119.012759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Implantable cardioverter-defibrillators (ICDs) are widely employed for the prevention of sudden cardiac death. Despite technological improvements, patients often need to undergo generator replacement, which entails the risk of periprocedural complications. Our aim was to estimate the service life of ICDs over a 10-year interval and to assess the main causes of replacement on the basis of data from the National ICD Registry of the Italian Society of Arrhythmology and Cardiac Pacing (AIAC). Methods and Results The registry includes data from over 400 hospitals in Italy. We included all patients who underwent device replacement from calendar years 2007 to 2016. The median service life of the ICDs and its trend over the years was estimated across the 3 types of devices (single-chamber, dual-chamber, cardiac resynchronization therapy defibrillator) and the indication to implantation. The causes of replacement were also analyzed. We included 29 158 records from 27 676 patients (80.9% men; mean age at device replacement 65.8±12.0 years). The median service life was 57.3 months (interquartile range 27.8 months). Over the years, service life showed an increasing trend. The majority of patients underwent elective replacement because of battery end of life, and over the years there was a significant reduction of replacement for recalls, erosion/infections, and cardiac resynchronization therapy upgrading. Conclusions Our data from a large single-nation population showed that the trend of ICD service life, independently from ICD type, indication, and settings, significantly improved over time. Moreover, there was a striking reduction of interventions for upgrading and infection/erosion. This favorable trend has important clinical, organizational, and financial implications.
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Affiliation(s)
- Stefano Poli
- Cardiology DivisionAzienda Sanitaria Universitaria Integrata di Udine and IRCAB FoundationUdineItaly
| | - Giuseppe Boriani
- Cardiology DivisionDepartment of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaPoliclinico di ModenaModenaItaly
| | - Massimo Zecchin
- Cardiovascular DepartmentAzienda Sanitaria Universitaria Integrata di TriesteTriesteItaly
| | - Domenico Facchin
- Cardiology DivisionAzienda Sanitaria Universitaria Integrata di Udine and IRCAB FoundationUdineItaly
| | - Maurizio Gasparini
- Electrophysiology and Pacing UnitHumanitas Research HospitalIRCCSRozzanoItaly
| | | | | | - Corrado Lanera
- Biostatistic UnitDepartment of Cardiac Thoracic Vascular Sciences and Public HealthUniversity of PadovaItaly
| | - Dario Gregori
- Biostatistic UnitDepartment of Cardiac Thoracic Vascular Sciences and Public HealthUniversity of PadovaItaly
| | - Alessandro Proclemer
- Cardiology DivisionAzienda Sanitaria Universitaria Integrata di Udine and IRCAB FoundationUdineItaly
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Lau EW. Longevity decoded: Insights from power consumption analyses into device construction and their clinical implications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:407-422. [PMID: 30802980 PMCID: PMC6850506 DOI: 10.1111/pace.13642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 01/02/2023]
Abstract
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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Affiliation(s)
- Ernest W Lau
- Department of Cardiology, Royal Victoria Hospital, Belfast, Northern Ireland
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Munawar DA, Mahajan R, Linz D, Wong GR, Khokhar KB, Thiyagarajah A, Kadhim K, Emami M, Mishima R, Elliott AD, Middeldorp ME, Roberts-Thompson KC, Young GD, Sanders P, Lau DH. Predicted longevity of contemporary cardiac implantable electronic devices: A call for industry-wide "standardized" reporting. Heart Rhythm 2018; 15:1756-1763. [PMID: 30063990 DOI: 10.1016/j.hrthm.2018.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Battery longevity is an important factor that may influence the selection of cardiac implantable electronic devices (CIEDs). However, there remains a lack of industry-wide standardized reporting of predicted CIED longevity to facilitate informed decision-making for implanting physicians and payers. OBJECTIVE The purpose of this study was to compare the predicted longevity of current generation CIEDs using best-matched CIEDs settings to assess differences between brands and models. METHODS Data were extracted for current model pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy-defibrillators (CRT-Ds) from product manuals and, where absent, by communication with the manufacturers. Pacemaker longevity estimations were based on standardized pacing outputs (2.5V, 0.40-ms pulse width, 500-Ω impedance) and pacing loads of 50% or 100% at 60 bpm. ICD and CRT-D longevity were estimated at 0% pacing and 15% atrial plus 100% biventricular pacing, with essential capacitor reforms and zero clinical shocks. RESULTS Mean maximum predicted longevity of single- and dual-chamber pacemakers was 12.0 ± 2.1 and 9.8 ± 1.9 years, respectively. Use of advanced features such as remote monitoring, prearrhythmia electrogram storage, and rate response can result in ∼1.4 years of reduction in longevity. Mean maximum predicted longevity of ICDs and CRT-Ds was 12.4 ± 3.0 and 8.8 ± 2.1 years, respectively. Of note, there were significant variations in predicted CIED longevity according to device manufacturers, with up to 44%, 42%, and 44% difference for pacemakers, ICDs, and CRT-Ds, respectively. CONCLUSION Contemporary CIEDs demonstrate highly variable predicted longevity according to device manufacturers. This may impact on health care costs and long-term clinical outcomes.
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Affiliation(s)
- Dian A Munawar
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Geoffrey R Wong
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kashif B Khokhar
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Anand Thiyagarajah
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kadhim Kadhim
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Mehrdad Emami
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo Mishima
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kurt C Roberts-Thompson
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Glenn D Young
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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Manolis AS, Maounis T, Koulouris S, Vassilikos V. "Real life" longevity of implantable cardioverter-defibrillator devices. Clin Cardiol 2017; 40:759-764. [PMID: 28543134 DOI: 10.1002/clc.22729] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Manufacturers of implantable cardioverter-defibrillators (ICDs) promise a 5- to 9-year projected longevity; however, real-life data indicate otherwise. The aim of the present study was to assess ICD longevity among 685 consecutive patients over the last 20 years. HYPOTHESIS Real-life longevity of ICDs may differ from that stated by the manufacturers. METHODS The study included 601 men and 84 women (mean age, 63.1 ± 13.3 years). The underlying disease was coronary (n = 396) or valvular (n = 15) disease, cardiomyopathy (n = 220), or electrical disease (n = 54). The mean ejection fraction was 35%. Devices were implanted for secondary (n = 562) or primary (n = 123) prevention. Single- (n = 292) or dual-chamber (n = 269) or cardiac resynchronization therapy (CRT) devices (n = 124) were implanted in the abdomen (n = 17) or chest (n = 668). RESULTS Over 20 years, ICD pulse generator replacements were performed in 238 patients (209 men; age 63.7 ± 13.9 years; ejection fraction, 37.7% ± 14.0%) who had an ICD for secondary (n = 210) or primary (n = 28) prevention. The mean ICD longevity was 58.3 ± 18.7 months. In 20 (8.4%) patients, devices exhibited premature battery depletion within 36 months. Most (94%) patients had none, minor, or modest use of ICD therapy. Longevity was longest for single-chamber devices and shortest for CRT devices. Latest-generation devices replaced over the second decade lasted longer compared with devices replaced during the first decade. When analyzed by manufacturer, Medtronic devices appeared to have longer longevity by 13 to 18 months. CONCLUSIONS ICDs continue to have limited longevity of 4.9 ± 1.6 years, and 8% demonstrate premature battery depletion by 3 years. CRT devices have the shortest longevity (mean, 3.8 years) by 13 to 17 months, compared with other ICD devices. These findings have important implications, particularly in view of the high expense involved with this type of electrical therapy.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Greece
| | | | | | - Vassilios Vassilikos
- Third Department of Cardiology, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gadler F, Ding Y, Verin N, Bergius M, Miller JD, Lenhart GM, Russell MW. Economic impact of longer battery life of cardiac resynchronization therapy defibrillators in Sweden. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:657-666. [PMID: 27826203 PMCID: PMC5096753 DOI: 10.2147/ceor.s114921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to quantify the impact that longer battery life of cardiac resynchronization therapy defibrillator (CRT-D) devices has on reducing the number of device replacements and associated costs of these replacements from a Swedish health care system perspective. METHODS An economic model based on real-world published data was developed to estimate cost savings and avoided device replacements for CRT-Ds with longer battery life compared with devices with industry-standard battery life expectancy. Base-case comparisons were performed among CRT-Ds of three manufacturers - Boston Scientific Corporation, St. Jude Medical, and Medtronic - over a 6-year time horizon, as per the available clinical data. As a sensitivity analysis, we evaluated CRT-Ds as well as single-chamber implantable cardioverter defibrillator (ICD-VR) and dual-chamber implantable cardioverter defibrillator (ICD-DR) devices over a longer 10-year period. All costs were in 2015 Swedish Krona (SEK) discounted at 3% per annum. RESULTS Base-case analysis results show that up to 603 replacements and up to SEK 60.4 million cumulative-associated costs could be avoided over 6 years by using devices with extended battery life. The pattern of savings over time suggests that savings are modest initially but increase rapidly beginning in the third year of follow-up with each year's cumulative savings two to three times the previous year. Evaluating CRT-D, ICD-VR, and ICD-DR devices together over a longer 10-year period, the sensitivity analysis showed 2,820 fewer replacement procedures and associated cost savings of SEK 249.3 million for all defibrillators with extended battery life. CONCLUSION Extended battery life is likely to reduce device replacements and associated complications and costs, which may result in important cost savings and a more efficient use of health care resources as well as a better quality of life for heart failure patients in Sweden.
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Affiliation(s)
- Fredrik Gadler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Yao Ding
- Truven Health Analytics, an IBM Company, Bethesda, MD, USA
| | - Nathalie Verin
- Boston Scientific Corporation, Hemel Hempstead, Hertfordshire, UK
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von Gunten S, Schaer BA, Yap SC, Szili-Torok T, Kühne M, Sticherling C, Osswald S, Theuns DAMJ. Longevity of implantable cardioverter defibrillators: a comparison among manufacturers and over time. Europace 2015; 18:710-7. [PMID: 26609076 PMCID: PMC4880113 DOI: 10.1093/europace/euv296] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/05/2015] [Indexed: 11/13/2022] Open
Abstract
Aims Longevity of implantable cardioverter defibrillators (ICDs) is crucial for patients and healthcare systems as replacements impact on infection rates and cost-effectiveness. Aim was to determine longevity using very large databases of two teaching hospitals with a high number of replacements and a rather homogeneous distribution among manufacturers. Methods and results The study population consists of all patients in whom an ICD was inserted in. All ICD manufacturers operating in Switzerland and the Netherlands and all implanted ICDs were included. Implantable cardioverter defibrillator replacements due to normal battery depletion were considered events, and other replacements were censored. Longevity was assessed depending on manufacturers, pacing mode, implant before/after 2006, and all parameters combined. We analysed data from 3436 patients in whom 4881 ICDs [44.2% VVI-ICDs, 27.4% DDD-ICDs, 26.3% cardiac resynchronization therapy (CRT)-ICDs, 2.0% subcutaneous ICDs] were implanted. The four major manufacturers had implant shares between 18.4 and 31.5%. Replacement due to battery depletion (27.4%) was performed for 1339 ICDs. Patient survival at 5 years was 80.1%. Longevity at 5 years improved in contemporary compared with elderly ICDs [63.9–80.6% across all ICDs, of 73.7–92.1% in VVIs, 58.2–76.1% in DDDs, and of 47.1–66.3% in CRT defibrillators, all P value < 0.05]. Remarkable differences were seen among manufacturers, and those with better performance in elderly ICDs were not those with better performance in contemporary ones. Conclusion Implantable cardioverter defibrillator longevity increased in contemporary models independent of manufacturer and pacing mode. Still, significant differences exist among manufacturers. These results might impact on device selection.
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Affiliation(s)
- Simon von Gunten
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Beat A Schaer
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michael Kühne
- Department of Cardiology, University Hospital, Basel, Switzerland
| | | | - Stefan Osswald
- Department of Cardiology, University Hospital, Basel, Switzerland
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Seegers J, Expósito PM, Lüthje L, Fischer T, Lueken M, Wenk H, Sossalla ST, Hasenfuss G, Zabel M. Longevity of implantable cardioverter-defibrillators in a single-center population. J Interv Card Electrophysiol 2015; 44:179-86. [DOI: 10.1007/s10840-015-0044-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
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Forces applied during transvenous implantable cardioverter defibrillator lead removal. BIOMED RESEARCH INTERNATIONAL 2014; 2014:183483. [PMID: 24967337 PMCID: PMC4055293 DOI: 10.1155/2014/183483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/09/2014] [Accepted: 04/29/2014] [Indexed: 12/04/2022]
Abstract
Methods. 17 physicians, experienced in transvenous lead removal, performed a lead extraction manoeuvre of an ICD lead on a torso phantom. They were advised to stop traction only when further traction would be considered as harmful to the patient or when—based on their experience—a change in the extraction strategy was indicated. Traction forces were recorded with a digital precision gauge. Results. Median traction forces on the endocardium were 10.9 N (range from 3.0 N to 24.7 N and interquartile range from 7.9 to 15.3). Forces applied to the proximal end were estimated to be 10% higher than those measured at the tip of the lead due to a friction loss. Conclusion. A traction force of around 11 N is typically exerted during standard transvenous extraction of ICD leads. A traction threshold for a safe procedure derived from a pool of experienced extractionists may be helpful for the development of required adequate simulator trainings.
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Siontis KC, Pantos I, Katritsis DG. Comparison of the longevity of implantable cardioverter-defibrillator devices by different manufacturers. Int J Cardiol 2014; 175:380-2. [PMID: 24874912 DOI: 10.1016/j.ijcard.2014.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ioannis Pantos
- Department of Cardiology, Athens Euroclinic, Athens, Greece; Medical and Radiation Physics, Department of Radiology, University of Athens, Greece
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