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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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Gierula J, Paton MF, Witte KK. Advances in cardiac resynchronization and implantable cardioverter/defibrillator therapy: Medtronic Cobalt and Crome. Future Cardiol 2021; 17:609-618. [PMID: 33635121 DOI: 10.2217/fca-2020-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular implantable electronic devices have revolutionized the management of heart failure with reduced ejection fraction. New device generations tend to be launched every few years, with incremental improvements in performance and safety and with an expectation that these will improve patient management and outcomes while remaining cost-effective. As a result, today's cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator devices are quite different from the pioneering but often bulky devices of the late 20th century. This review discusses new and improved features developed to target specific needs in managing heart failure patients, some of which are especially pertinent to the current worldwide healthcare situation, with focus on the latest generation of CRTs with defibrillator (CRT-Ds) and implantable cardioverter defibrillators from Medtronic.
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Affiliation(s)
- John Gierula
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
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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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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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