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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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Censi F, Calcagnini G, Mattei E, Ricci RP, Zoni Berisso M, Landolina M, Boriani G. Estimate and reporting of longevity for cardiac implantable electronic devices: a proposal for standardized criteria. Expert Rev Med Devices 2021; 18:1203-1208. [PMID: 34854774 DOI: 10.1080/17434440.2021.2013199] [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: 10/19/2022]
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are widely used according to consensus guidelines in various patient categories. The longevity of CIED is a major determinant of the frequency with which patients require device replacement. Given the mismatch between the useful life of the devices and patient survival, device replacement is often needed. There is a great variability in the criteria used by manufacturers to determine the longevity of pacemakers (PM), implantable defibrillators (ICDs), and devices for cardiac resynchronization therapy (CRT). Thus, a fair comparison and an effective device evaluation is often difficult. METHODS The objective of this paper is to provide standardized criteria based on typical clinical settings for estimating the longevity of single and dual chamber ICDs, cardiac resynchronization defibrillators (CRT-D), single and dual chamber PMs, and cardiac resynchronization PMs (CRT- P) to be used in health technology assessment for an appropriate comparison among different devices. RESULTS The proposed parameters, if applied to the current marketed devices, provide longevity values in the range 5-17.2 years. CONCLUSION The values of longevity with the non-standardized criteria used by the manufacturers result in higher maximum values respect to the proposed standardized criteria for CRT-D, CRTD-MPP, CRT-P, and Dual-chamber PM.
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Affiliation(s)
- Federica Censi
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Giovanni Calcagnini
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Eugenio Mattei
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | | | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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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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Zungsontiporn N, Loguidice M, Daniels J. Important Parameters for Implantable Cardioverter Defibrillator Selection. Card Electrophysiol Clin 2019; 10:145-152. [PMID: 29428136 DOI: 10.1016/j.ccep.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The efficacy of implantable cardioverter defibrillators in reducing the risk of sudden cardiac death has been well established by several clinical trials. Several factors relating to device characteristics, patient attributes, and comorbidities should be considered when selecting the appropriate implantable cardioverter defibrillators for each patient. This review examines some of these issues.
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Affiliation(s)
- Nath Zungsontiporn
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Michael Loguidice
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - James Daniels
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Reisman AM, Farrell K, Leitman IM. Value Analysis of the Costliest Elective Lifesaving Procedures at an Academic Medical Center. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2018. [DOI: 10.29024/jsim.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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Boriani G, Merino J, Wright DJ, Gadler F, Schaer B, Landolina M. Battery longevity of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators: technical, clinical and economic aspects. An expert review paper from EHRA. Europace 2018; 20:1882-1897. [DOI: 10.1093/europace/euy066] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Josè Merino
- Arrhythmia and Robotic Electrophysiology Unit, Hospital Universitario La Paz, Universidad Europea, Madrid, Spain
| | - David J Wright
- Cardiology Division, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Fredrik Gadler
- Heart and Vascular Theme, Karolinska Institute of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, Switzerland
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Nakou ES, Simantirakis EN, Kallergis EM, Nakos KS, Vardas PE. Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting. Europace 2018; 19:705-711. [PMID: 28011795 DOI: 10.1093/europace/euw317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted cardiac resynchronization therapy (CRT) devices that are nearing end-of-life. The individual patient's clinical status and concomitant morbidities may evolve so that considerations may include not only replacement of the pulse generator, but also potentially changing the type of device [e.g. downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]. Moreover, the clinical evidence for CRT-D/CRT-P implantation may change over time, with ongoing research and availability of new trial data. In this review we discuss the ethical, clinical and financial implications related to CRT generator replacements and the need for additional clinical trials to better understand which patients should undergo CRT device downgrading or upgrading at the time of battery depletion.
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Affiliation(s)
- Eleni S Nakou
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | | | | | - Konstantinos S Nakos
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | - Panos E Vardas
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
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Lüker J, Sultan A, Plenge T, van den Bruck J, Heeger CH, Meyer S, Mischke K, Tilz RR, Vollmann D, Nölker G, Schäffer B, Willems S, Steven D. Electrical cardioversion of patients with implanted pacemaker or cardioverter-defibrillator: results of a survey of german centers and systematic review of the literature. Clin Res Cardiol 2017; 107:249-258. [PMID: 29151182 DOI: 10.1007/s00392-017-1178-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/06/2017] [Indexed: 01/08/2023]
Abstract
AIMS A relevant number of patients presenting for electrical cardioversion carry a pacemaker (PM) or ICD. Case reports suggest a potential hazard of external cardioversion/defibrillation. The incidence of shock related device complications is unknown. No guidelines or recommendations by international medical societies for a cardioversion protocol of cardiovascular implantable electronic device (CIED) patients exist. We conducted a nationwide survey to gather real-world clinical data on the current clinical approach towards these patients during electrical cardioversion and to estimate the incidence of shock-related complications. METHODS AND RESULTS Ninety hospitals with > 380 ECV in 2014 were identified from mandatory hospital quality reports and 60 were randomly selected. All centers were provided with a standardized questionnaire on the general proceedings and complications during electrical cardioversion of pacemaker, ICD and CRT patients (CIED patients). Thirty-two centers (53%) participated in the survey. In total, 16,554 ECV were reported (534 ± 314 per center). Biphasic cardioversion with a first shock energy of ≥ 150 J via adhesive patches in antero-posterior orientation was preferred by most centers (78%). Eleven percent (n = 1809) of pts were reported to carry a PM/ICD. The ECV protocol was heterogeneous among centers. Complications associated with electrical cardioversion were reported in 11/1809 patients (0.6%), all were transitory elevations of pacing thresholds. CONCLUSIONS In this nationwide snapshot survey of cardioversion procedures in Germany, approximately 11% of patients presenting for elective electrical cardioversion were pacemaker or ICD carriers. Cardioversion protocols in these patients are heterogeneous throughout centers and mostly not in accordance with recommendation of the German Cardiac Society. Complications associated with external electrical cardioversion are rare. Controlled trials and large registries are necessary to provide evidence for future recommendations.
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Affiliation(s)
- J Lüker
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany.
| | - A Sultan
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - T Plenge
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - J van den Bruck
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - C-H Heeger
- Department of Cardiology, Asklepios Klinik St.Georg, Hamburg, Germany
| | - S Meyer
- Department of Cardiology, Hospital Oldenburg, Oldenburg, Germany
| | - K Mischke
- Department of Cardiology, University Hospital Aachen, Aachen, Germany
| | - R R Tilz
- Department of Cardiology, University Hospital Lübeck, Lübeck, Germany
| | - D Vollmann
- Herz- & Gefäßzentrum Göttingen, Göttingen, Germany
| | - G Nölker
- Clinic for Cardiology, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - B Schäffer
- Department of Electrophysiology, University Heart Center, Hamburg, Germany
| | - S Willems
- Department of Electrophysiology, University Heart Center, Hamburg, Germany
| | - D Steven
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
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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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Zanon F, Martignani C, Ammendola E, Menardi E, Narducci ML, DE Filippo P, Santamaria M, Campana A, Stabile G, Potenza DR, Pastore G, Iori M, LA Rosa C, Biffi M. Device Longevity in a Contemporary Cohort of ICD/CRT-D Patients Undergoing Device Replacement. J Cardiovasc Electrophysiol 2016; 27:840-5. [PMID: 27094359 DOI: 10.1111/jce.12990] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The longevity of defibrillators (ICD) is extremely important from both a clinical and economic perspective. We studied the reasons for device replacement, the longevity of removed ICD, and the existence of possible factors associated with shorter service life. METHODS AND RESULTS Consecutive patients who underwent ICD replacement from March 2013 to May 2015 in 36 Italian centers were included in this analysis. Data on replaced devices were collected. A total of 953 patients were included in this analysis. In 813 (85%) patients the reason for replacement was battery depletion, while 88 (9%) devices were removed for clinical reasons and the remaining 52 because of system failure (i.e., lead or ICD generator failure or a safety advisory indication). The median service life was 5.9 years (25th-75th percentile, 4.9-6.9) for single- and dual-chamber ICD and 4.9 years (25th-75th percentile, 4.0-5.7) for CRT-D. On multivariate analysis, the factors CRT-D device, SC/DC ICD generator from Biotronik, percentage of ventricular pacing, and the occurrence of a system failure were positively associated with a replacement procedure. By contrast, the device from Boston Scientific was an independent protective factor against replacement. Considerable differences were seen in battery duration in both ICD and CRT-D. Specifically, Biotronik devices showed the shortest longevity among ICD and Boston Scientific showed the longest longevity among CRT-D (log-rank test, P < 0.001 for pairwise comparisons). CONCLUSION Several factors were associated with shorter service life of ICD devices: CRT-D, occurrence of system failure and percentage of ventricular pacing. Our results confirmed significant differences among manufacturers.
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Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Cristian Martignani
- Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Endrj Menardi
- Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy
| | - Maria Lucia Narducci
- Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy
| | - Paolo DE Filippo
- Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Matteo Santamaria
- Cardiovascular and Arrhythmias Department, Giovanni Paolo II Research & Care Foundation, Campobasso, Italy
| | - Andrea Campana
- Medical-Surgical Department of Cardiology, Azienda Ospedaliera "Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | | | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Matteo Iori
- Unit of Cardiac Surgery Department of Cardiology Thoracic and Vascular Surgery and Critical Care Medicine, Azienda Ospedaliera ASMN Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | | | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
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ELLIS CHRISTOPHERR, DICKERMAN DEANNAI, ORTON JODIM, HASSAN SOHAIL, GOOD ERICD, OKABE TOSHIMASA, ANDRIULLI JOHNA, QUAN KARAJ, GREENSPON ARNOLDJ. Ampere Hour as a Predictor of Cardiac Resynchronization Defibrillator Pulse Generator Battery Longevity: A Multicenter Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:658-68. [DOI: 10.1111/pace.12831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- CHRISTOPHER R. ELLIS
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee
| | | | - JODI M. ORTON
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee
| | | | - ERIC D. GOOD
- University of Michigan/Cardiovascular Center; Ann Arbor Michigan
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Boriani G, Ritter P, Biffi M, Ziacchi M, Diemberger I, Martignani C, Valzania C, Valsecchi S, Padeletti L, Gadler F. Battery drain in daily practice and medium-term projections on longevity of cardioverter-defibrillators: an analysis from a remote monitoring database. Europace 2016; 18:1366-73. [PMID: 26847076 PMCID: PMC5006961 DOI: 10.1093/europace/euv436] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/02/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS The longevity of generators is a crucial determinant of the cost-effectiveness of therapy with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). We evaluated the trend of device-measured residual battery capacity and longevity projections over 5-year follow-up. We also investigated possible factors associated with battery drain. METHODS AND RESULTS Data from 4851 patients in the European LATITUDE(®) database who were followed up for a minimum of 3 years were analysed. The factors associated with battery drain (i.e. year-to-year decrease in residual battery capacity), and thus potentially impacting on device longevity, were mainly the pacing parameters in CRT-D devices and the number of shocks delivered and diverted in both ICD and CRT-D (all P < 0.01 on linear regression analysis). Over the first 5 years, the longevity estimates provided by devices showed low intra-patient variability and increased with time. The estimates exceeded 10 years for CRT-D and 13 and 12 years for single- and dual-chamber ICDs, respectively. In CRT-D patients, the expected patient age on replacement was 80 ± 12 years, and the expected probability of undergoing device replacement was 63 ± 13% for New York Heart Association (NYHA) II patients and 37 ± 16% for NYHA III patients. For comparison, the probabilities of replacing a CRT-D lasting 5 years were 78 ± 8 and 59 ± 13%, respectively (both P < 0.001). CONCLUSION Battery drain was mainly associated with pacing output in CRT-D devices and with the number of capacitor charges in both ICD and CRT-D devices. The longevity estimates provided by the devices were consistent and conservative. According to these estimates, among CRT-D recipients a low proportion of patients should require device replacement.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy Department of Cardiology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Igor Diemberger
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Cristian Martignani
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Cinzia Valzania
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | | | - Luigi Padeletti
- University of Florence, Florence, Italy IRCCS MultiMedica, Sesto San Giovanni, Italy
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15
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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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16
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Longevity of the Subcutaneous Implantable Defibrillator. Circ Arrhythm Electrophysiol 2015; 8:1159-63. [DOI: 10.1161/circep.115.002953] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/24/2015] [Indexed: 02/06/2023]
Abstract
Background—
The recent advent of subcutaneous implantable cardioverter defibrillators (S-ICDs) has provided investigators with a safe and effective new therapy in patients at risk of sudden cardiac death. At present, no data are available with regard to the longevity of these new devices. This study evaluated the longevity of the S-ICD system.
Methods and Results—
All patients enrolled in the European Regulatory Trial were included in the analysis. During follow-up, time and causes of device replacement or explantation were assessed and categorized. Device longevity was estimated using Kaplan–Meier analysis. Fifty-five patients were followed for a median of 5.8 years. During follow-up, 26 (47%) patients underwent device replacement and 5 (9%) underwent device explantation. Median time to replacement was 5.0 years (Q1–Q3, 4.4–5.6 years). Replacement was caused by battery depletion in 25 patients (92%), of which 5 within 1.5 years because of premature battery depletion, and by infection in 1 patient (2%). Replacement for a transvenous ICD system was required in 4 patients (7%) because of ineffective defibrillation in 1 (0.003 per patient-year), need for resynchronization therapy in 2 (0.01 per patient-year), and for antibradycardia pacing in 1 (0.003 per patient-year). At 5 years follow-up, 71% of devices were still in service.
Conclusions—
This study provides the first estimate of S-ICD system longevity since its introduction in clinical practice. Median longevity of the first generation S-ICD system was 5.0 years. The majority of devices were replaced because of battery depletion.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01117792.
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Burri H. Longevity of biventricular defibrillators: not all devices are created equal. Europace 2015; 17:1166-8. [PMID: 26273103 DOI: 10.1093/europace/euv225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haran Burri
- Electrophysiology Unit, Cardiology Service, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, Geneva 14 1211, Switzerland
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18
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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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19
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Colquitt JL, Mendes D, Clegg AJ, Harris P, Cooper K, Picot J, Bryant J. Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation. Health Technol Assess 2015; 18:1-560. [PMID: 25169727 DOI: 10.3310/hta18560] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This assessment updates and expands on two previous technology assessments that evaluated implantable cardioverter defibrillators (ICDs) for arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure (HF). OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of ICDs in addition to optimal pharmacological therapy (OPT) for people at increased risk of sudden cardiac death (SCD) as a result of ventricular arrhythmias despite receiving OPT; to assess CRT with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for people with HF as a result of left ventricular systolic dysfunction (LVSD) and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in addition to OPT for people with both conditions. DATA SOURCES Electronic resources including MEDLINE, EMBASE and The Cochrane Library were searched from inception to November 2012. Additional studies were sought from reference lists, clinical experts and manufacturers' submissions to the National Institute for Health and Care Excellence. REVIEW METHODS Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Data were synthesised through narrative review and meta-analyses. For the three populations above, randomised controlled trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were eligible. Outcomes included mortality, adverse events and quality of life. A previously developed Markov model was adapted to estimate the cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations by simulating disease progression calculated at 4-weekly cycles over a lifetime horizon. RESULTS A total of 4556 references were identified, of which 26 RCTs were included in the review: 13 compared ICD with medical therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with ICD. ICDs reduced all-cause mortality in people at increased risk of SCD, defined in trials as those with previous ventricular arrhythmias/cardiac arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF and left ventricular ejection fraction ≤ 35%. There was no benefit in people scheduled for coronary artery bypass graft. A reduction in SCD but not all-cause mortality was found in people with recent MI. Incremental cost-effectiveness ratios (ICERs) ranged from £14,231 per quality-adjusted life-year (QALY) to £29,756 per QALY for the scenarios modelled. CRT-P and CRT-D reduced mortality and HF hospitalisations, and improved other outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony when compared with OPT. The rate of SCD was lower with CRT-D than with CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT produced ICERs of £27,584 per QALY and £27,899 per QALY respectively. The ICER for CRT-D compared with CRT-P was £28,420 per QALY. In people with both conditions, CRT-D reduced the risk of all-cause mortality and HF hospitalisation, and improved other outcomes, compared with ICDs. Complications were more common with CRT-D. Initial management with OPT alone was most cost-effective (ICER £2824 per QALY compared with ICD) when health-related quality of life was kept constant over time. Costs and QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with ICD was £27,195 per QALY and that for CRT-D compared with OPT was £35,193 per QALY. LIMITATIONS Limitations of the model include the structural assumptions made about disease progression and treatment provision, the extrapolation of trial survival estimates over time and the assumptions made around parameter values when evidence was not available for specific patient groups. CONCLUSIONS In people at risk of SCD as a result of ventricular arrhythmias and in those with HF as a result of LVSD and cardiac dyssynchrony, the interventions modelled produced ICERs of < £30,000 per QALY gained. In people with both conditions, the ICER for CRT-D compared with ICD, but not CRT-D compared with OPT, was < £30,000 per QALY, and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing CRT-D and CRT-P in people with HF as a result of LVSD and cardiac dyssynchrony is required, for both those with and those without an ICD indication. A RCT is also needed into the benefits of ICD in non-ischaemic cardiomyopathy in the absence of dyssynchrony. STUDY REGISTRATION This study is registered as PROSPERO number CRD42012002062. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jill L Colquitt
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Diana Mendes
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Andrew J Clegg
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Joanna Picot
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jackie Bryant
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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20
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Landolina M, Curnis A, Morani G, Vado A, Ammendola E, D'onofrio A, Stabile G, Crosato M, Petracci B, Ceriotti C, Bontempi L, Morosato M, Ballari GP, Gasparini M. Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer. Europace 2015; 17:1251-8. [PMID: 25976906 PMCID: PMC4535557 DOI: 10.1093/europace/euv109] [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: 02/16/2015] [Accepted: 03/28/2015] [Indexed: 11/29/2022] Open
Abstract
Aims Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices. Methods and results We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57–2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25–2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45–0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47–0.89; P = 0.008) were additional factors associated with replacement for battery depletion. Conclusion The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers.
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Affiliation(s)
- Maurizio Landolina
- Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy Dipartimento di Cardiologia, A.O. Ospedale Maggiore di Crema, Largo Ugo Dossena 2, Crema (Cremona) 26013, Italy
| | | | | | | | | | | | | | | | | | - Carlo Ceriotti
- Humanitas Research Hospital IRCCS, Rozzano (Milan), Italy
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Neuzner J. The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries. Clin Res Cardiol 2015; 104:456-60. [PMID: 25690935 DOI: 10.1007/s00392-014-0807-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
In 2005, Bob Hauser published a paper in the Journal of the American College of Cardiology entitled "The growing mismatch between patient longevity and the service life of Implantable Cardioverter-Defibrillators". Now, nearly a decade later, I would like to perform a second look on the problem of a mismatching between ICD device service life and the survival of ICD recipients. Since 2005, the demographics of the ICD population has changed significantly. Primary prevention has become the dominant indication in defibrillator therapy and device implantation is indicated more and more in earlier stages of cardiac diseases. In former larger scale ICD trials, the patient average 5-year survival probability was in a range of 68-71%; in newer CRT-D trials in a range of 72-88%. Due to a progressively widened ICD indication and implantation preferentially performed in patients with better life expectancy, the problem of inadequate device service life is of growing importance. The early days of defibrillator therapy started with a generator volume of 145 ccm and a device service life <18 months. In this early period, the device miniaturization and extension of service life were similar challenges for the technicians. Today, we have reached a formerly unexpected extent of device miniaturization. However, technologic improvements were often preferentially translated in further device miniaturization and not in prolonging device service life. In his analysis, Bob Hauser reported a prolonged device service life of 2.3 years in ICD models with a larger battery capacity of 0.54 up to 0.69 Ah. Between 2008 and 2014, several studies had been published on the problem of ICD longevity in clinical scenarios. These analyses included "older" and currently used single chamber, dual chamber and CRT devices. The reported average 5-year device service life ranged from 0 to 75%. Assuming today technology, larger battery capacities will only result in minimal increase in device volume. Selected ICD patients may further benefit from device miniaturization-but the vast majority may much more benefit from a significant prolongation in device service life. All published cost-effectiveness analyses in ICD therapy show that device costs and device service life are the dominant determinants of the results. The performed "second look-nearly a decade later" revealed that there are still relevant limitations regarding the device service life in current defibrillator therapy. Technical improvements were preferentially transformed into device miniaturization but not into prolonging device service life. But this optimization is strongly enforced. The most feasible solution might be the use of device batteries with larger capacities. The economic burden, mainly caused by non-adequate device service life, may limit the future realization of ICD therapy in a progressively growing patient population. In the former years, physicians and device manufacturers have ignored the patient perspective in defibrillator therapy. However, it is the patient viewpoint that prolonged device service life is much more important than smaller generator size.
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Affiliation(s)
- Jörg Neuzner
- Medizinische Klinik II, Klinikum Kassel, Mönchebergstrasse 41-43, 34125, Kassel, Germany,
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22
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Horlbeck FW, Schwab JO. Programming implantable cardioverter/defibrillators and outcomes. F1000PRIME REPORTS 2015; 7:10. [PMID: 25705393 PMCID: PMC4311272 DOI: 10.12703/p7-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Implantable cardioverter-defibrillators are complex technical devices with a multitude of programming options for the physician. In recent years, numerous randomized trials have been performed to define the optimal programming strategies and have provided valuable insights, especially in primary prevention patients. This article provides an actual overview on the existing evidence on the most important programming features for accurate detection and therapy of ventricular arrhythmias.
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Fontenla A, López Gil M, Martínez Ferrer J, Alzueta J, Fernández Lozano I, Viñolas X, Rodríguez A, Fernández de la Concha J, Anguera I, Arribas F. Perfil clínico e incidencia de arritmias ventriculares de los pacientes sometidos a recambio de generador de desfibrilador en España. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fontenla A, López Gil M, Martínez Ferrer J, Alzueta J, Fernández Lozano I, Viñolas X, Rodríguez A, Fernández de la Concha J, Anguera I, Arribas F. Clinical profile and incidence of ventricular arrhythmia in patients undergoing defibrillator generator replacement in Spain. ACTA ACUST UNITED AC 2014; 67:986-92. [PMID: 25432708 DOI: 10.1016/j.rec.2014.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/17/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Implantable cardioverter-defibrillators reduce mortality in some patients with heart disease. Battery replacement is a frequent occurrence in clinical practice and is required in up to 30% of implants. The benefit/risk ratio of defibrillators varies over time and should be reevaluated at the time of replacement. The aim of this study was to determine the clinical characteristics and incidence of defibrillator therapies in patients who underwent generator replacement. METHODS This multicenter retrospective study involved patients from the UMBRELLA national registry who underwent replacement due to defibrillator battery depletion. The incidence of ventricular arrhythmias was determined via remote monitoring. Risk factors for sustained ventricular arrhythmia after replacement were analyzed. RESULTS A total of 354 patients were included (mean age [standard deviation], 61.8 [14.5] years; men, 80%; secondary prevention, 42%; ventricular arrhythmias in the explanted generator, 62%). After a 25-month follow-up, 70 patients (20%) received appropriate therapies and 8 (2.3%) received inappropriate discharges. Male sex, structural heart disease, heart failure, and the absence of resynchronization were independent predictors of ventricular arrhythmia occurrence. CONCLUSIONS One-fifth of patients had appropriate defibrillator therapies in the first 2 years after generator replacement. Determination of the factors associated with arrhythmia occurrence after replacement may be useful to optimize implantable cardioverter-defibrillator treatment.
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Affiliation(s)
- Adolfo Fontenla
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - María López Gil
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Martínez Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Araba, Vitoria, Álava, Spain
| | - Javier Alzueta
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Ignacio Fernández Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Xavier Viñolas
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aníbal Rodríguez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | | | - Ignasi Anguera
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Arribas
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Yap SC, Schaer BA, Bhagwandien RE, Kühne M, Dabiri Abkenari L, Osswald S, Szili-Torok T, Sticherling C, Theuns DAMJ. Evaluation of the need of elective implantable cardioverter-defibrillator generator replacement in primary prevention patients without prior appropriate ICD therapy. Heart 2014; 100:1188-92. [DOI: 10.1136/heartjnl-2014-305535] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Gillis AM, Kerr CR, Philippon F, Newton G, Talajic M, Froeschl M, Froeschl S, Swiggum E, Yetisir E, Wells GA, Tang AS. Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. Circulation 2014; 129:2021-30. [DOI: 10.1161/circulationaha.112.000417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anne M Gillis
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Charles R. Kerr
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - François Philippon
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Gary Newton
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Mario Talajic
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Michael Froeschl
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Sandra Froeschl
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Elizabeth Swiggum
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Elizabeth Yetisir
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - George A. Wells
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
| | - Anthony S. Tang
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul’s Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa,
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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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Schaer BA, Osswald S, Di Valentino M, Soliman OI, Sticherling C, ten Cate FJ, Jordaens L, Theuns DA. Close connection between improvement in left ventricular function by cardiac resynchronization therapy and the incidence of arrhythmias in cardiac resynchronization therapy-defibrillator patients. Eur J Heart Fail 2014; 12:1325-32. [DOI: 10.1093/eurjhf/hfq171] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Beat A. Schaer
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Stefan Osswald
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
| | - Marcello Di Valentino
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
| | - Osama I. Soliman
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Christian Sticherling
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
| | - Folkert J. ten Cate
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Luc Jordaens
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Dominic A. Theuns
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
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Alam MB, Munir MB, Rattan R, Flanigan S, Adelstein E, Jain S, Saba S. Battery longevity in cardiac resynchronization therapy implantable cardioverter defibrillators. Europace 2013; 16:246-51. [PMID: 24099864 DOI: 10.1093/europace/eut301] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) implantable cardioverter defibrillators (ICDs) deliver high burden ventricular pacing to heart failure patients, which has a significant effect on battery longevity. The aim of this study was to investigate whether battery longevity is comparable for CRT-ICDs from different manufacturers in a contemporary cohort of patients. METHODS AND RESULTS All the CRT-ICDs implanted at our institution from 1 January 2008 to 31 December 2010 were included in this analysis. Baseline demographic and clinical data were collected on all patients using the electronic medical record. Detailed device information was collected on all patients from scanned device printouts obtained during routine follow-up. The primary endpoint was device replacement for battery reaching the elective replacement indicator (ERI). A total of 646 patients (age 69 ± 13 years), implanted with CRT-ICDs (Boston Scientific 173, Medtronic 416, and St Jude Medical 57) were included in this analysis. During 2.7 ± 1.5 years follow-up, 113 (17%) devices had reached ERI (Boston scientific 4%, Medtronic 25%, and St Jude Medical 7%, P < 0.001). The 4-year survival rate of device battery was significantly worse for Medtronic devices compared with devices from other manufacturers (94% for Boston scientific, 67% for Medtronic, and 92% for St Jude Medical, P < 0.001). The difference in battery longevity by manufacturer was independent of pacing burden, lead parameters, and burden of ICD therapy. CONCLUSION There are significant discrepancies in CRT-ICD battery longevity by manufacturer. These data have important implications on clinical practice and patient outcomes.
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Affiliation(s)
- Mian Bilal Alam
- Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH B535, Pittsburgh, PA 15213, USA
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30
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Gupta A, Dharmarajan K, Dreyer R, Bikdeli B, Chen R, Kulkarni VT, Shi R, Shojaee A, Ranasinghe I. Most Important Outcomes Research Papers on Device Therapies for Cardiomyopathies. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.113.000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Bavikati VV, Langberg JJ, Williams BR, Kella D, Lloyd MS. Stimulus intensity in left ventricular leads and response to cardiac resynchronization therapy. J Am Heart Assoc 2013; 1:e000950. [PMID: 23316285 PMCID: PMC3541614 DOI: 10.1161/jaha.112.000950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 07/23/2012] [Indexed: 12/02/2022]
Abstract
Background Increased left ventricular (LV) stimulus intensity has been shown to improve conduction velocity and cardiac output. However, high-output pacing would shorten device battery life. Our prospective trial analyzed the clinical effects of high- versus low-output LV pacing. Methods and Results Thirty-nine patients undergoing initial cardiac resynchronization therapy device implantation with bipolar LV leads were assigned to 3 months of either high-output LV pacing (Hi) or low-output LV pacing (Lo) in a randomized, blinded crossover fashion. Hi and Lo settings were determined with a rigorous intraoperative protocol specific to each patient. Clinical and echocardiographic data were obtained at randomization, at 3 months, and a subsequent 3 months after crossover. Mean age was 66.4±9.8 years, and mean QRS duration was 159.3±23.1 ms. Compared to baseline, both arms had significant improvements in Minnesota Living With Heart Failure score (given as mean [95% confidence interval]) (baseline versus Lo: 43.3 [35.5 to 51.1] versus 21.3 [14.6 to 28.0], P<0.01; baseline versus Hi: 43.3 [35.5 to 51.1] versus 23.6 [16.1 to 31.1], P<0.01) and 6-minute walk distance (baseline versus Lo: 692 ft [581 to 804] versus 995 ft [876 to 1114], P<0.01; baseline versus Hi: 699 ft [585 to 813] versus 982 ft [857 to 1106], P<0.01). Although both Hi and Lo arms had some echocardiographic parameters that significantly improved compared to baseline (baseline end-diastolic diameter 5.7 cm [5.5 to 6.0] versus Lo 5.5 cm [5.1 to 5.8], P<0.01; baseline end-systolic diameter 4.9 cm [4.6 to 5.3] versus Hi 4.7 cm [4.3 to 5.0], P<0.05), there were no significant differences observed when comparing the Hi- versus Lo-output arms. Conclusions Low-output LV pacing with a relatively narrow safety margin above capture threshold affords significant improvement from baseline and is clinically equivalent to high-output LV pacing. These data support a strategy of minimizing the programmed LV safety margin to increase battery life in cardiac resynchronization therapy devices. Clinical Trial Registration Information URL: http://www.clinicaltrials.gov. Unique identifier: NCT01060449
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Singh HR, Batra AS, Balaji S. Cardiac pacing and defibrillation in children and young adults. Indian Pacing Electrophysiol J 2013; 13:4-13. [PMID: 23329870 PMCID: PMC3539397 DOI: 10.1016/s0972-6292(16)30584-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The population of children and young adults requiring a cardiac pacing device has been consistently increasing. The current generation of devices are small with a longer battery life, programming capabilities that can cater to the demands of the young patients and ability to treat brady and tachyarrhythmias as well as heart failure. This has increased the scope and clinical indications of using these devices. As patients with congenital heart disease (CHD) comprise majority of these patients requiring devices, the knowledge of indications, pacing leads and devices, anatomical variations and the technical skills required are different than that required in the adult population. In this review we attempt to discuss these specific points in detail to improve the understanding of cardiac pacing in children and young adults.
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Affiliation(s)
- Harinder R Singh
- The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan
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33
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Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand. Heart Lung Circ 2012; 21:765-77. [DOI: 10.1016/j.hlc.2012.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
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HORLBECK FRITZW, MELLERT FRITZ, KREUZ JENS, NICKENIG GEORG, SCHWAB JOERGO. Real-World Data on the Lifespan of Implantable Cardioverter-Defibrillators Depending on Manufacturers and the Amount of Ventricular Pacing. J Cardiovasc Electrophysiol 2012; 23:1336-42. [DOI: 10.1111/j.1540-8167.2012.02408.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Shafat T, Baumfeld Y, Novack V, Konstantino Y, Amit G. Significant differences in the expected versus observed longevity of implantable cardioverter defibrillators (ICDs). Clin Res Cardiol 2012; 102:43-9. [PMID: 22798033 DOI: 10.1007/s00392-012-0493-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 07/04/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) is a life-saving therapy for patients at risk of ventricular arrhythmias. Due to its high cost, its cost-effectiveness is highly dependent on its longevity, which is currently only based upon the manufacturer's predicted device life span. AIM We sought to assess the ICDs' longevity and the factors influencing it, and to compare the observed (real life) to the expected (manufacturer's prediction) life span at a device level. METHODS We retrospectively identified all patients who underwent an ICD implantation in a tertiary care medical center. For each device, an expected longevity was assigned based on the manufacturer/model, pacing percentage, and number of shocks per year. We defined device failure if the observed survival was shorter than 80 % of the expected. Only devices with follow-up time that exceeded the expected longevity were included. RESULTS Of the 275 devices in the cohort, 79 (29 %) failed. Median device longevity was 5 years and varied markedly between manufacturers (4.3, 4.8, 5.1, and 6.3 years for Biotronik, St. Jude Medical, Boston Scientific, and Medtronic, respectively). There were significant differences among the manufacturers in device failure rates: 48, 17, 22, and 14 % for Biotronik, St. Jude Medical, Boston Scientific, and Medtronic, respectively). In multivariate analysis, manufacturer, earlier year of implantation, congestive heart failure and chronic renal failure significantly predicted device failure. CONCLUSIONS In conclusion, there is a significant device failure rate among ICDs, with variability among manufacturers, impacting both patients and the medical economic systems.
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Affiliation(s)
- Tali Shafat
- Department of Cardiology, Soroka University Medical Center, POB 151, 84101, Beer-Sheva, Israel
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Wilson D, Shi B, Harding S, Lever N, Larsen P. Implantable cardioverter-defibrillators: a long-term view. Intern Med J 2012; 42:554-61. [DOI: 10.1111/j.1445-5994.2011.02710.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schaer B, Sticherling C. Expecting the unpredictable. Heart Rhythm 2012; 9:721-2. [DOI: 10.1016/j.hrthm.2012.01.003] [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: 01/01/2012] [Indexed: 11/24/2022]
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Ozcan C, Rottman JN, Heist EK, Guy ML, Ellinor PT, Singh J, Milan DJ, Danik SB, Barrett CD, Mansour M, Ruskin JN, Mela T. Unpredictable battery depletion of St Jude Atlas II and Atlas+ II HF implantable cardioverter-defibrillators. Heart Rhythm 2012; 9:717-20. [DOI: 10.1016/j.hrthm.2011.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Indexed: 10/14/2022]
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Thijssen J, Borleffs CJW, van Rees JB, Man S, de Bie MK, Venlet J, van der Velde ET, van Erven L, Schalij MJ. Implantable cardioverter-defibrillator longevity under clinical circumstances: An analysis according to device type, generation, and manufacturer. Heart Rhythm 2012; 9:513-9. [DOI: 10.1016/j.hrthm.2011.11.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Indexed: 01/03/2023]
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40
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Cardiac device infections are associated with a significant mortality risk. Heart Rhythm 2012; 9:494-8. [DOI: 10.1016/j.hrthm.2011.10.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/30/2011] [Indexed: 11/18/2022]
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Russo AM. The reality of implantable cardioverter-defibrillator longevity: what can be done to improve cost-effectiveness? Heart Rhythm 2011; 9:520-1. [PMID: 22172319 DOI: 10.1016/j.hrthm.2011.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 10/14/2022]
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How to truly value implantable cardioverter-defibrillators technology: up-front cost or daily cost? Int J Technol Assess Health Care 2011; 27:201-6. [PMID: 21756409 DOI: 10.1017/s0266462311000183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We calculated the daily cost of implantable cardioverter-defibrillators (ICDs) based on their actual longevity to prove whether the up-front cost is a reliable parameter for the ICD purchasing-process. METHODS. Longevity of single chamber (SC), double chamber (DC), and biventricular (BiV) ICDs from Medtronic (MDT), Guidant (GDT), and St. Jude Medical (SJM) was measured in all the patients implanted in years 2000, 2001, 2002 who reached device replacement within December 31, 2009. The cost of each ICD (device + lead/s) was normalized for its own longevity. Data are expressed as median (25th-75th percentile). RESULTS A total of 123/153 patients completed the study, 70 percent being alive 8 years after implantation. MDT devices had a superior longevity compared with GDT and SJM (p < .001). Fifty-eight percent of replaced ICDs had a service life at least 1 year shorter than the manufacturers' prediction. Longer-lasting devices had a significantly lower daily cost: €4.8 (4.6-5.7) versus €6.8 (6.2-9.2) and €6.9 (6.2-7.6) for SC (p < .001); €6.9 (6.8-7.7) versus €12.6 (11.8-13.3) and €13.4 (10.3-16.1) for DC; €8.5 (8.3-10.3) versus €15.4 (15.1-15.8) and €14.6 (14.1-14.9) for BiV (p < .005). CONCLUSIONS The true cost of ICD treatment is strictly dependent on device longevity, whereas device up-front cost is unreliable. This aspect should be valued in the technology purchasing process, and could set the basis for an outcome-based reimbursement system. Our observations may be the benchmark respectively for ICD longevity and daily ICD cost in future comparisons. Independent observations in the real-life scenario are needed to properly value newer technologic improvements.
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Reichlin T, Kühne M, Sticherling C, Osswald S, Schaer B. Characterization and financial impact of implantable cardioverter-defibrillator patients without interventions 5 years after implantation. QJM 2011; 104:849-57. [PMID: 21624895 DOI: 10.1093/qjmed/hcr081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD's) are increasingly used for primary and secondary prevention of sudden cardiac death. However, data on how many ICD patients indeed receive appropriate ICD therapy during long-term follow-up is scarce. AIM The aim of our study was to determine the number of patients without appropriate ICD therapy 5 years after ICD implantation, to identify predicting factors, to assess the occurrence of late first ICD therapy and to quantify the financial impact of ICD therapy in a real-world setting. DESIGN Prospective observational study. METHODS We prospectively enrolled 322 consecutive ICD patients. Baseline data were collected at implantation and patients were followed for a median of 7.3 years (IQR 5.8-9.2 years). Time to first appropriate ICD therapy (either antitachycardia pacing or cardioversion) was documented. RESULTS Five years after implantation, 139 patients (43%) had not received appropriate ICD therapy. In multivariable analysis, a primary prevention indication and negative electrophysiological studies prior to ICD implantation were independent predictors of freedom from ICD therapy. Of the patients without ICD therapy, 5 years after implantation, 25% had experienced inappropriate ICD shocks. Two hundred and seven devices (1.5 devices per patient) were needed for the 139 patients without ICD intervention within 5 years, accounting for € 31,784 per patient. During an additional follow-up of 3 years, 12% of the patients with unused ICD received a late first appropriate ICD therapy. CONCLUSION About half of the ICD patients receive appropriate ICD therapy within 5 years after implantation. Furthermore, there is a significant proportion of patients receiving late first shocks after five initially uneventful years.
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Affiliation(s)
- T Reichlin
- Department of Internal Medicine, Division of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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45
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Gandjour A, Holler A, Adarkwah CC. Cost-effectiveness of implantable defibrillators after myocardial infarction based on 8-year follow-up data (MADIT II). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:812-817. [PMID: 21914500 DOI: 10.1016/j.jval.2011.02.1180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 01/16/2011] [Accepted: 02/27/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES About 190,000 Germans experience a myocardial infarction each year. Of these, 25% may be eligible for an implantable cardioverter defibrillator (ICD) due to low left ventricular ejection fraction. Given the high costs of implantation, the purpose of this study was to assess the cost-effectiveness of ICDs compared to conventional therapy in patients with an ejection fraction 30% or less after MI in Germany. METHODS The economic evaluation was performed from the perspective of the German statutory health insurance. To simulate costs and effectiveness over lifetime, a Markov model was constructed with seven health states. The model was based on 8-year follow-up data for ICD implantation after myocardial infarction (MADIT II), which was published recently. RESULTS The analysis shows that ICD implantation compared to conventional therapy in patients fulfilling MADIT-II criteria has a cost-effectiveness ratio of €44,736 per quality-adjusted life year gained. If every patient insured by the statutory health insurance and fulfilling the MADIT-II criteria would receive an ICD, the model suggests expenditures between €173 million and €1.7 billion per year. CONCLUSIONS ICD therapy cannot be considered clearly cost-effective when compared to many well-accepted interventions. If policy makers decide to reimburse ICDs in the MADIT-II population, they will need to either raise premiums or abandon coverage for other currently funded medical interventions.
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Affiliation(s)
- Afschin Gandjour
- Pennington Biomedical Research Center/Louisiana State University, Baton Rouge, LA 70808, USA.
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Lambert P, Da Costa A, Marcy PY, Kreps S, Angellier G, Marcié S, Bondiau PY, Briand-Amoros C, Thariat J. [Pacemaker, implanted cardiac defibrillator and irradiation: Management proposal in 2010 depending on the type of cardiac stimulator and prognosis and location of cancer]. Cancer Radiother 2011; 15:238-49; quiz 257. [PMID: 21435931 DOI: 10.1016/j.canrad.2010.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 12/19/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
Abstract
Ionizing radiation may interfere with electric components of pacemakers or implantable cardioverter-defibrillators. The type, severity and extent of radiation damage to pacemakers, have previously been shown to depend on the total dose and dose rate. Over 300,000 new cancer cases are treated yearly in France, among which 60% are irradiated in the course of their disease. One among 400 of these patients has an implanted pacemaker or defibrillator. The incidence of pacemaker and implanted cardioverter defribillator increases in an ageing population. The oncologic prognosis must be weighted against the cardiologic prognosis in a multidisciplinary and transversal setting. Innovative irradiation techniques and technological sophistications of pacemakers and implantable cardioverter-defibrillators (with the introduction of more radiosensitive complementary metal-oxide-semiconductors since 1970) have potentially changed the tolerance profiles. This review of the literature studied the geometric, dosimetric and radiobiological characteristics of the radiation beams for high energy photons, stereotactic irradiation, protontherapy. Standardized protocols and radiotherapy optimization (particle, treatment fields, energy) are advisable in order to improve patient management during radiotherapy and prolonged monitoring is necessary following radiation therapy. The dose received at the pacemaker/heart should be calculated. The threshold for the cumulated dose to the pacemaker/implantable cardioverter-defibrillator (2 to 5 Gy depending on the brand), the necessity to remove/displace the device based on the dose-volume histogram on dosimetry, as well as the use of lead shielding and magnet are discussed.
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Affiliation(s)
- P Lambert
- Service d'anesthésie réanimation, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, France
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MANSOUR FADI, KHAIRY PAUL. Programming ICDs in the Modern Era beyond Out-of-the Box Settings. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:506-20. [DOI: 10.1111/j.1540-8159.2011.03037.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Neyt M, Van Brabandt H. Response to letter: Pitfalls in economic analysis. Europace 2010. [DOI: 10.1093/europace/euq123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cowie MR. Response to Editorial: Pitfalls in economic analysis. Europace 2010; 12:1044-6; author reply 1046-7. [DOI: 10.1093/europace/euq105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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