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Hauser RG, Casey SA, Gitter CB, Tang CY, Abdelhadi RH, Gornick CC, Stanberry L, Sengupta JD. Reliability and longevity of implantable defibrillators. J Interv Card Electrophysiol 2021; 62:507-518. [PMID: 33387130 PMCID: PMC8645539 DOI: 10.1007/s10840-020-00920-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/23/2020] [Indexed: 12/04/2022]
Abstract
Purpose We hypothesized that data in manufacturers’ product performance reports (PPRs) can provide clinically valuable ICD and cardiac resynchronization defibrillator (CRT-D) reliability and longevity information. Methods Data were obtained from 2019 PPRs. Kaplan-Meier (K-M) probabilities of freedom from malfunction, normal battery depletion (NBD), and NBD + malfunction were calculated for ICD and CRT-D pulse generators (PGs) with LiMnO2 or LiSVO/CFx batteries marketed in the USA from 2010 to 2019 and compared using the log-rank test. Malfunctions (MAL) included PGs that were found outside specifications. Results Study population included 1,149,803 ICD and CRT-D PGs: Abbott (ABT; 35.1%), Biotronik (BIO; 4.6%), Boston Scientific (BSC; 23.5%), and Medtronic (MDT; 36.9%). Significant differences in reliability (p < 0.001), defined by freedom from MAL, were found between manufacturers; the majority of 6808 MAL occurred in ABT devices (n = 4045; 59.4%), followed by BSC (n = 2384; 35.0%), MDT (n = 338;5.0%), and BIO (n = 41; 0.6%). Battery failure (n = 890; 57.9%) was the most common cause of MAL compromising therapy; analysis of unique ABT battery MAL–indicated problem appeared a year prior to advisory. Significant differences (p < 0.001) in battery longevity, as defined by freedom from NBD, were found between manufacturers. Overall performance (freedom from NBD + MAL) favored BSC for CRT-D PGs and MDT and BIO for ICDs. BSC subcutaneous ICD reliability was inferior to its transvenous ICD (p < 0.001). Conclusion PPRs contain valuable data that can be aggregated and analyzed to inform physicians. Differences in product reliability exist between manufacturers. Battery longevity has improved, but MAL have significantly impacted performance. PPR data may be useful for assessing product problems and new technology.
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Song SL. HRS 40th anniversary viewpoints: A serendipitous encounter in the world of pacing. Heart Rhythm 2019; 16:956-957. [DOI: 10.1016/j.hrthm.2019.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Indexed: 11/16/2022]
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HAUSER ROBERTG. Lessons from ICD Lead Recalls: What Have We Learned? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:650-1. [DOI: 10.1111/j.1540-8159.2012.03366.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lall P, Gupta P, Kulkarni M, Hofmeister J. Time–Frequency and Autoregressive Techniques for Prognostication of Shock-Impact Reliability of Implantable Biological Electronic Systems. ACTA ACUST UNITED AC 2010. [DOI: 10.1109/tepm.2010.2078824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Peinado R, Torrecilla EG, Ormaetxe J, Alvarez M. Registro Español de Desfibrilador Automático Implantable. II Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (2005). Rev Esp Cardiol 2006; 59:1292-302. [PMID: 17194425 DOI: 10.1157/13096579] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE We report the results for the Spanish Registry on Implantable Cardioverter Defibrillators (ICD) (year 2005), developed by the Working Group on ICD of the Spanish Society of Cardiology. METHODS Data were collected (prospectively in 77% of implants) by single page form questionnaires transmitted after the procedure to the Spanish Society of Cardiology. Participation was voluntary. RESULTS The number of implants sent to the Registry was 2050 and this represents 74.4% of the total ICDs implanted. The implantation rate per million was 46.5 and the estimated total implantation rate per million was 62.5. The proportion of first implants was 70.3%. The majority of patients were males, with a median age of 65 years, severe or moderate to severe left ventricular dysfunction and in functional class II or I. Ischemic heart disease was the more frequent underlying heart disease followed by dilated cardiomyopathy. The main reason for ICD indication was secondary prevention related to sustained monomorphic ventricular tachycardia or aborted sudden cardiac death. A significant number of prophylactic indications were done, specially in non ischemic heart disease. The proportion of ICD implanted at the electrophysiology laboratory by cardiac electrophysiologist continues increasing. There was an increase in the number of ICD plus cardiac resynchronization therapy, that represent a 23.6% of the implants. The incidence of complications during the implant was very low. CONCLUSIONS The National Registry on ICD, with a participation rate greater than in previous years, provides a representative sample of the ICD implants performed at our country.
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Hauser RG, Hayes DL, Epstein AE, Cannom DS, Vlay SC, Song SL, Tyers GFO. Multicenter experience with failed and recalled implantable cardioverter-defibrillator pulse generators. Heart Rhythm 2006; 3:640-4. [PMID: 16731462 DOI: 10.1016/j.hrthm.2006.02.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Accepted: 02/06/2006] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the widespread and growing use of implantable cardioverter-defibrillators (ICDs), little information is available regarding their performance or the impact of advanced pacing functions on ICD reliability and longevity. OBJECTIVES The purpose of this study was to examine the performance of contemporary ICD pulse generators that failed or were replaced because of manufacturers recalls. METHODS ICD data were entered prospectively by nine participating centers. ICD pulse generator failure was defined as removal from service because the device was not functioning according to the manufacturer's specifications. A recalled ICD was a normally functioning pulse generator that was replaced as the result of a recall or advisory. RESULTS From 1998 to 2005, 1,220 ICDs failed and 135 were recalled and replaced. The average implant time of failed ICDs was 4.4 +/- 1.5 years and of recalled ICDs was 1.7 +/- 0.8 years. The average implant time of single- and dual-chamber ICDs with rate responsive or cardiac resynchronization (CRT-D) pacing capabilities was significantly shorter than the average implant time of single- or dual-chamber devices without these features (P <.001). ICDs that provided rate responsive or CRT-D pacing failed earlier because of battery depletion (P <.001) and were significantly more prone to unexpected electronic or housing failure (9% vs 5%, P = .008) and recalls (25% vs 1%, P <.0001). Major adverse events included death (n = 2), failure to convert ventricular tachyarrhythmias (n = 6), and inappropriate shocks (n = 11). CONCLUSION Based on our analysis of failed and recalled devices, the performance of contemporary ICDs has been adversely affected by premature battery depletion, electronic failure, and manufacturers' recalls. Additional studies are needed to precisely estimate ICD longevity and to determine the incidence of unexpected ICD failure.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minnesota 55407, USA.
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Peinado R, Arenal Á, Arribas F, Torrecilla E, Álvarez M, Ormaetxe JM, Pérez-Castellano N. Registro Español de Desfibrilador Automático Implantable. Primer Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (años 2002-2004). Rev Esp Cardiol 2005. [DOI: 10.1016/s0300-8932(05)74074-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maisel WH. Cardiovascular device development: lessons learned from pacemaker and implantable cardioverter-defibrillator therapy. Am J Ther 2005; 12:183-5. [PMID: 15767838 DOI: 10.1097/01.mjt.0000155117.55919.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) therapy are two examples of remarkable technological advances that have revolutionized cardiovascular device therapy. Understanding the history of early PM and ICD device development, recognizing the importance of the clinical data that was required to launch the current "era" of exponential device use, and appreciating the challenge of maintaining device innovation without sacrificing device reliability, are important lessons that may offer insights into future cardiovascular device development.
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Affiliation(s)
- William H Maisel
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Fauchier L, de Bouët du Portal H, Giraudeau C, Froger S, Cosnay P, Babuty D. [Postmarketing surveillance in patients with cardiac pace-makers or automatic implantable defibrillators]. Ann Cardiol Angeiol (Paris) 2005; 54:38-43. [PMID: 15702910 DOI: 10.1016/j.ancard.2004.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
This article includes an overview of the actual French control and regulation system of the safety alerts involving pacemakers and implantable cardioverter-defibrillator and an evaluation of the general information and trends about the characteristics of the reported incidents obtained in the last years in that field. The national security agencies have the mission to collect the data on safety and efficacy of medical devices but manufacturers, physicians and patients also have a role to play. The technical appreciation of the necessity of a notification is not easy in some cases but the lack of notification of a severe incident may lead to heavy penal consequences. If doubtful cases, one should keep in mind the spirit of these safety systems: a collective insurance against the risks related to the use of medical devices. In the 10 last years, the annual advisory rate was increased. The pacemakers were recalled more frequently than implantable cardioverter-defibrillators in absolute value but less frequently in relative value (advisories per 100 person-years). This increase may be related to the growing number of device implants and expanding indications for device therapy, to the increasing sophistication of the devices and to the modifications in the regulation aspects of these problems with a closer attention of users and physicians to the several types of malfunctions.
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Affiliation(s)
- L Fauchier
- Service de cardiologie B et laboratoire d'électrophysiologie cardiaque, centre hospitalier universitaire Trousseau, 37044 Tours cedex, France.
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Wild DM, Fisher JD, Kim SG, Ferrick KJ, Gross JN, Palma EC. Pacemakers and Implantable Cardioverter Defibrillators:. Device Longevity Is More Important Than Smaller Size: The Patient's Viewpoint. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1526-9. [PMID: 15546308 DOI: 10.1111/j.1540-8159.2004.00671.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices. It is uncertain whether this tradeoff for smaller size is desired by patients. We surveyed 156 patients to determine whether patients prefer a larger, longer-lasting device, or a smaller device that is less noticeable but requires more frequent surgery. The effects of subgroups were evaluated; these included body habitus, age, gender, and patients seen at time of pulse generator replacement (PGR), initial implant, or follow-up. Among 156 patients surveyed, 151 expressed a preference. Of these, 90.1% preferred the larger device and 9.9% the smaller device (P <0.0001). Among thin patients, 79.5% preferred a larger device. Ninety percent of males and 89.2% of females selected the larger device. Among younger patients (< or =72 years), 89.6% preferred the larger device, as did 90.5% of older patients (>72 years). Of patients undergoing PGR or initial implants, 95% favored the larger device, as did 86% of patients presenting for follow-up. The vast majority of patients prefer a larger device to reduce the number of potential replacement operations. This preference crosses the spectrum of those with a previously implanted device, those undergoing initial implants, those returning for routine follow-up, and patients of various ages, gender, and habitus.
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Affiliation(s)
- David M Wild
- Department of Medicine, Cardiology Division, Arrhythmia Service, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10497, USA
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Affiliation(s)
- Seymour Furman
- Arrhythmia Service, Division of Cardiology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Hildick-Smith DJ, Walsh JT. Single-chamber versus dual-chamber pacemakers. N Engl J Med 1998; 339:630; author reply 631-2. [PMID: 9722435 DOI: 10.1056/nejm199808273390913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Böcker D, Block M, Hindricks G, Borggrefe M, Breithardt G. Antiarrhythmic therapy--future trends and forecast for the 21st century. Am J Cardiol 1997; 80:99G-104G. [PMID: 9354417 DOI: 10.1016/s0002-9149(97)00719-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This article discusses recent changes in antiarrhythmic therapy, with a focus on nonpharmacologic therapy (electrode catheter ablation, implantable cardioverter-defibrillators [ICDs]), and puts them into perspective for the coming years. The treatment of supraventricular tachycardias and tachycardia involving accessory pathways is likely to remain the domain of catheter ablation. With promising new techniques under investigation, the spectrum of arrhythmias that can be cured will probably be expanded. Treatment of life-threatening ventricular arrhythmias is likely to remain the domain of the ICD in the foreseeable future. With the safety net of the ICD in place, new antiarrhythmic drugs or other forms of antiarrhythmic therapy can be developed and tested.
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Affiliation(s)
- D Böcker
- Department of Cardiology and Angiology and Institute for Arteriosclerosis Research, Hospital of the Westfälische Wilhelms-University, Münster, Germany
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Platt S, Furman S, Gross JN, Andrews C, Benedek M. Transtelephone monitoring for pacemaker follow-up 1981-1994. Pacing Clin Electrophysiol 1996; 19:2089-98. [PMID: 8994948 DOI: 10.1111/j.1540-8159.1996.tb03283.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Transtelephone monitoring (TTM) is capable of detecting pacemaker pulse generator malfunction, battery depletion, and lead failure. The accuracy of TTM was analyzed by a review of Montefiore Medical Center records between October 1981 and March 1994. Each group of transmissions from a single patient, starting with implant and ending with a pacemaker operation, was defined as a closed cycle (CLOSE), if undergoing continuing follow-up at the time of analysis, as a continuing cycle (CONT), and if a cycle had ended with death or loss to follow-up, an open cycle (OPEN). TTM records of 2,632 patients were analyzed, providing 3,291 cycles. There were 731 CONT, 433 CLOSE, and 2,127 OPEN cycles; 331 procedures were indicated by TTM, of which 279 were impending depletion, 30 sudden depletion, and 22 lead malfunctions. Of the 102 procedures not indicated by TTM, 85 were for nonurgent reasons (recall: 41; DDD upgrade: 16; patient/MD request: 28) and 17 for urgent reasons. In patients followed by TTM who had a lead problem, 22 were detected by TTM before clinical manifestations and 16 were not. There were no cases in which TTM follow-up did not detect battery depletion. The total number of TTM contacts, available for 3,094 cycles, was 88,654 (range, 1-163, median 19), of which 0.4% yielded a procedure. During the same period, 75% of all secondary interventions during the first 2 years occurred during the first 2 months after implant because of lead malfunction, with a subsequent SI rate of 0.005 per month for the third through the twenty-fourth months.
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Affiliation(s)
- S Platt
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467-2409, USA
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Kawanishi DT, Song S, Furman S, Parsonnet V, Pioger G, Petitot JC, Godin JF. Failure rates of leads, pulse generators, and programmers have not diminished over the last 20 years: formal monitoring of performance is still needed. BILITCH Registry and STIMAREC. Pacing Clin Electrophysiol 1996; 19:1819-23. [PMID: 8945048 DOI: 10.1111/j.1540-8159.1996.tb03232.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Formal Monitoring of Performance is Still Needed. In order to detect trends in the number of device or component failures that have occurred among permanent pacemaker systems since the 1970s, we reviewed the data of the five largest pacemaker manufacturers from the Bilitch Registry of permanent pacemaker pulse generators, the Stimarec failure registry, the general accounting office summaries of the United States Veterans Administration (VA) Registry of Pacemaker Leads, and the Implantable Lead Registry, from the Cleveland Clinic Lead registry, and the recalls and safety alerts issued by the United States Food and Drug Administration (FDA) over the last 20 years. The definition of failure followed the criterion, or criteria, developed within each registry and differed significantly between the registries. The 20-year period between 1976 and 1995 was divided into 5-year quartiles (QT): QT 1 = 1976-1980; QT2 = 1981-1985; QT3 = 1986-1990; and QT4 = 1991-1995. For pulse generators, the number of models with failures in each quartile in the Bilitch Registry were: QT 1 = 9; QT 2 = 11; QT3 = 17; QT4 = 13. In Stimarec, the number of units reported as having reached a dangerous condition were: QT1 = 710; QT2 = 212; QT3 = 114; QT4 = 310. From the FDA reports, the number of units included in recalls or safety alerts were: QT3 = 6,085; QT4 = 135,766. For permanent pacemaker leads, the numbers of failed or dangerous leads recorded in Stimarec were: QT3 = 16; QT4 = 32. In the VA Registry, the number of models having a below average survival was 2/92 (2.7%). In the Implantable Lead Registry, the number of models having a below average survival was 3/21 (14%). In the Cleveland Clinic series, 6/13 (46%) of lead models were recognized to have some failure involving the conductor, insulation, or connector. In the FDA reports, the number of leads involved in either recall or safety alert were: QT3 = 20,354; QT4 = 332,105. For programmers, the number of units involved either in a recall or safety alert were: QT3 = 11,124; QT4 = 3,528. In all of these series, each of the five largest manufacturers had some models or units involved in each time period. This review of programs has revealed: 1. The incidence of failures, recalls, or safety alerts did not decline over time; and 2. Despite changes in technology, formal monitoring of pacemaker systems is still warranted.
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Affiliation(s)
- D T Kawanishi
- University of Southern California Pacemaker Center, Los Angeles 221-4428, USA
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Abstract
The long-term costs of cardiac pacing include the device costs, the procedural costs, the follow-up costs, and the replacement costs. At present, there is significant variability in the efficiencies of the integrated circuits and the total battery capacity among different pulse generators that will influence replacement rates over time. Accordingly, we compared the influence of pulse generator longevity on the long-term costs of pacing. The longevity of pulse generators was calculated based on the electrical characteristics of the device and the percentage of time the patient is paced. Replacement rates of pulse generators were estimated for our patient population over a 20-year period, based on patient survival and pulse generator longevity. The costs of pacing over this 20-year follow-up period were then calculated. The longevity of DDDR devices presently implanted in the United States ranges from 8-14 years, assuming that patients are paced 50% of the time. Replacement rates in this population over a 20-year follow-up period were calculated to range from 0.34-0.66, and the total costs of pacing would range from $11,898-14,900 per patient. The longevity of SSIR devices ranges from 7-20 years, assuming that patients are paced 50% of the time. Replacement rates were calculated over the 20-year follow-up period to range from 0.20-0.84, and the total costs of VVIR pacing would range from $8,331-13,286. Based on the proportion of pulse generator models implanted in patients in the United States, the maximum cost differential to the health care system is approximately $424 million/year comparing the devices with the shortest and greatest longevities. Thus, pulse generator longevity may significantly influence the long-term costs of pacing. Patient survival and pulse generator system longevity should be considered when selecting the appropriate pacing system for the individual patient.
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Affiliation(s)
- A M Gillis
- Division of Cardiology, Foothills Hospital, Calgary, Alberta, Canada.
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Abstract
This pilot study focuses on pacemaker follow-up in the technically stable period 1-5 years after a pacemaker implantation. Two hundred and thirty selected patients with single chamber pacemakers (215 VVI, 15 AAI) had their follow-up intervals prolonged to 2-4 years in this period. Sixty-six patients fulfilled the study period uneventfully and 21 are still pending. Sixty-nine patients had unscheduled visits to the pacemaker clinic. Of these, 7 were reoperated (1 for exit block, 4 had pocket erosions, and 2 were upgraded to DDD). Nine were reprogrammed (1 for sensing failure, 1 had the pulse duration increased, and in 7 the pacing rate was changed). Seventy-four patients died. In 63, the cause of death is known not to be pacemaker related. Six died suddenly, and in five cases, the cause of death is unknown. This study indicates that frequent follow-up visits may be omitted in this period in selected patients with single chamber pacemakers. A prerequisite is that the patients are registered at a pacemaker clinic and have easy access to the physician whenever they suspect pacemaker related problems.
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Affiliation(s)
- H Grendahl
- Department of Cardiology, Ullevål Hospital, Oslo, Norway
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Saksena S, Breithardt G, Dorian P, Greene HL, Madan N, Block M. Nonpharmacological therapy for malignant ventricular arrhythmias: implantable defibrillator trials. Prog Cardiovasc Dis 1996; 38:429-44. [PMID: 8638024 DOI: 10.1016/s0033-0620(96)80007-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) are an important nonpharmacological option in the treatment of malignant ventricular arrhythmias. Technological advances in current devices permit nonthoracotomy implantation with transvenous lead systems using biphasic shocks. Decreasing device size has resulted in pectoral implantation. Battery longevity is still short in comparison with that of pacemakers. Lead failure rates as well as pacing thresholds are significantly higher than those for cardiac pacing lead systems. Other complications of ICD systems include infection, perforation, and thrombosis. The long-term performance of nonthoracotomy lead systems for ICD devices has now been extensively studied. Sudden death recurrence rates for these systems are less than 2% in 3 years and less than 5% at 5 years. Clinical trials with both monophasic and biphasic systems show a high degree of prevention of sudden death. Comparison of ICD outcome with that of drug therapy in three large retrospective studies and two small prospective randomized trials favors improved survival and sudden death prevention with device therapy. However, these studies need corroboration from large prospective trials. Two large prospective trials, CIDS and the AVID study, are now in progress to address this issue.
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Affiliation(s)
- S Saksena
- Division of Cardiology, Eastern Heart Institute, Passaic, NJ, USA
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Furman S, Benedek ZM, Andrews CA, Gross JN, Ritacco R. Long-term follow-up of pacemaker lead systems: establishment of standards of quality. Pacing Clin Electrophysiol 1995; 18:271-85. [PMID: 7731875 DOI: 10.1111/j.1540-8159.1995.tb02517.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The functional details of all 5,405 pacemaker leads implanted on Montefiore Medical Center were contemporaneously recorded between 1960 and May 31, 1993. Some models have been observed for as long as 24 years. Ventricular leads with more than 50 and atrial leads with more than 30 implanted units have been continually and repeatedly subjected to actuarial cumulative survival rate (CSR) analysis during which clinical decisions, such as continued lead implantation, cessation of use, or early withdrawal from service, were made. CSR evaluation for many lead models by the Mantel-Haenszel method allowed comparison of the performance of contemporaneous lead models with older and new technologies. No effect on lead longevity, durability, on mode of end of lead service, lead removal independent of function (e.g., for infection), materials, or physiological failure was found due to an operator or anatomical route of venous access. Multifilar silicone rubber insulated leads have longevity (CSR) superior to monofilar silicone rubber leads. The cumulative survival of silicone rubber insulated monofilar models 6901, 6907, continuous lead (CL), 4 mm, and 2 mm was 79%-91%, 20 years after implantation. Multifilar silicone rubber insulated models 6961 and 4116 had a cumulative survival of 99%-100%, 15 years after implantation. Among multifilar polyurethane insulated leads, distinct longevity differences exist between formulations and contemporaneous models that are normally similar, yielding a bimodal longevity distinction; model 6971 (ventricular) has 95% CSR and 6991U (atrial) has 94% CSR, 10 years after implantation. Both performed less well than other contemporaneous models, which approximate 100% CSR. The 10-year CSR for leads implanted between 1960-1975 (Era 1) is 98.7%, and the 10-year CSR of leads implanted between 1981-1985 (Era 3) is 99.4%. Comparison of individual lead models, and all leads of specific eras, allows development of survival expectations and standards of quality for comparison between contemporaneous lead models and different eras of manufacture. As the highest available lead CSR sets the standard, statistical deviation of a model from the best performance of a specific era should be considered as an indication of reduced quality.
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Affiliation(s)
- S Furman
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
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