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Carlson D, Marine JE, Love CJ, Chrispin J, Barth AS, Rickard JJ, Spragg DD, Berger R, Calkins H, Tomaselli GF, Sinha SK. Electrocardiographic predictors of pacemaker battery depletion: Diagnostic sensitivity, specificity, and clinical risk. Pacing Clin Electrophysiol 2019; 43:2-9. [PMID: 31691986 DOI: 10.1111/pace.13831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pacemaker battery depletion triggers alert for replacement notification and results in automatic reprogramming, which has been shown to be associated with relevant cardiorespiratory symptoms and adverse clinical events. OBJECTIVE Determine if electrocardiogram (ECG) pacing features may be predictive of pacemaker battery depletion and clinical risk. METHODS This is an ECG substudy of a cohort analysis of 298 subjects referred for pacemaker generator replacement from 2006 to 2017. Electronic medical record review was performed; clinical, ECG, and pacemaker characteristics were abstracted. We applied two ECG prediction rules for pacemaker battery depletion that are relevant to all major pacemaker manufacturers except Boston Scientific and MicroPort: (1) atrial pacing not at a multiple of 10 and (2) nonsynchronous ventricular pacing not at a multiple of 10, to determine diagnostic sensitivity, specificity, and risk in applicable ECG subjects. RESULTS We excluded 32 subjects not at replacement notification or duplicate surgeries. Overall, 176 of 266 subjects (66.2%) demonstrated atrial pacing or nonsynchronous ventricular pacing on preoperative ECG. When utilizing both rules, 139 of 176 preoperative ECGs and 12 of 163 postoperative ECGs met criteria for battery depletion yielding reasonable sensitivity (79.0%), high specificity (92.6%), and a positive likelihood ratio of 11.6:1. These rules were associated with significant increase in cardiorespiratory symptoms (P < .001) and adverse clinical events (P < .025). CONCLUSIONS The "Rules of Ten" provided reasonable sensitivity and specificity for detecting replacement notification in pacemaker subjects with an applicable ECG. This ECG tool may help clinicians identify most patients with pacemaker battery depletion at significant clinical risk.
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Affiliation(s)
- Daniel Carlson
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles J Love
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas S Barth
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Jack Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Sunil K Sinha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Sinha SK, Carlson D, Chrispin J, Barth AS, Rickard JJ, Spragg DD, Berger R, Love C, Calkins H, Tomaselli GF, Marine JE. The Symptoms and Clinical events associated with Automatic Reprogramming (SCARE) at replacement notification study. Pacing Clin Electrophysiol 2018; 41:1611-1618. [PMID: 30375674 DOI: 10.1111/pace.13532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pacemaker patients experience battery depletion that activates pacemaker's alert for replacement notification. Automatic reprogramming at replacement notification can result in loss of rate response and atrioventricular (AV) synchrony. OBJECTIVE To determine if relevant symptoms or clinical events may be associated with automatic reprogramming at replacement notification. METHODS Electronic medical record review was undertaken for 298 patients referred for pacemaker generator replacement. Primary endpoints were symptoms or clinical events during replacement notification period. RESULTS Following elimination of duplicate pacemaker replacements (n = 12), "near-replacement notification" or "recalled" (n = 15) and pacemakers at "end of life" (n = 5), 266 subjects were included. Three distinct reprogramming cohorts were identified; those with no change (control) in pacing mode (n = 46), those with loss of rate response (n = 154), and those with loss of AV synchrony ± rate response (n = 66). In total, 83 subjects (31.2%) had symptoms with significant differences seen between groups (control = 4.3%, loss of rate response = 26.0%, loss of AV synchrony ± rate response = 62.1%, P < 0.001). Overall, 28 subjects (10.5%) experienced clinical events with significant differences seen between groups (control = 0.0%, loss of rate response = 6.5%, loss of AV synchrony ± rate response = 27.3%, P < 0.001). CONCLUSIONS Automatic reprogramming at replacement notification was associated with significant symptoms in 26% of those who lost rate response and in 62% of those who lost AV synchrony ± rate response. Additionally, 27% of the latter cohort required nonelective clinical care.
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Affiliation(s)
- Sunil K Sinha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Carlson
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andreas S Barth
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Jack Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Love
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gordon F Tomaselli
- Department of Medicine (Cardiology), The Albert Einstein College of Medicine, New York City, NY, USA
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sinha SK, Sivasambu B, Yenokyan G, Crawford TC, Chrispin J, Eagle KA, Barth AS, Rickard JJ, Spragg DD, Vlay SC, Berger R, Love C, Calkins H, Tomaselli GF, Marine JE. Worldwide pacemaker and defibrillator reuse: Systematic review and meta-analysis of contemporary trials. Pacing Clin Electrophysiol 2018; 41:1500-1507. [PMID: 30191580 DOI: 10.1111/pace.13488] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients go without pacemaker, defibrillator, and cardiac resynchronization therapies (devices) each year due to the prohibitive costs of devices. OBJECTIVE We sought to examine data available from studies regarding contemporary risks of reused devices in comparison with new devices. METHODS We searched online indexing sites to identify recent studies. Peer-reviewed manuscripts reporting infection, malfunction, premature battery depletion, and device-related death with reused devices were included. The primary study outcome was the composite risk of infection, malfunction, premature battery depletion, and death. Secondary outcomes were the individual risks. RESULTS Nine observational studies (published 2009-2017) were identified totaling 2,302 devices (2,017 pacemakers, 285 defibrillators). Five controlled trials were included in meta-analysis (2,114 devices; 1,258 new vs 856 reused). All device reuse protocols employed interrogation to confirm longevity and functionality, disinfectant therapy, and, usually, additional biocidal agents, packaging, and ethylene oxide gas sterilization. Demographic characteristics, indications for pacing, and median follow-up were similar. There were no device-related deaths reported and no statistically significant difference in risk between new versus reused devices for the primary outcome (2.23% vs 3.86% respectively, P = 0.807, odds ratio = 0.76). There were no significant differences seen in the secondary outcomes for the individual risks of infection, malfunction, and premature battery depletion. CONCLUSIONS Device reuse utilizing modern protocols did not significantly increase risk of infection, malfunction, premature battery depletion, or device-related death in observational studies. These data provide rationale for proceeding with a prospective multicenter noninferiority randomized control trial.
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Affiliation(s)
- Sunil K Sinha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhradeev Sivasambu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas C Crawford
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kim A Eagle
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andreas S Barth
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Jack Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Vlay
- SUNY Health Sciences Center, Stony Brook University, Stony Brook, NY, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Love
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sinha SK, Chrispin J, Barth A, Rickard JJ, Spragg DD, Berger R, Calkins H, Tomaselli G, Marine JE. Clinical recognition of pacemaker battery depletion and automatic reprogramming. Pacing Clin Electrophysiol 2017; 40:969-974. [PMID: 28617963 DOI: 10.1111/pace.13135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/27/2022]
Abstract
All contemporary pacemakers undergo automatic reprogramming upon reaching elective replacement indication due to battery depletion. The majority of such reprogramming will result in changes to both pacing mode and pacing rate. The exact software reprogramming varies considerably among pacemaker manufacturers and may even vary among models of the same manufacturer. Accordingly, it is essential for healthcare providers managing pacemaker patients to have a detailed understanding of the automatic reprogramming seen at elective replacement indication as well as their potential physiological and clinical consequences.
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Affiliation(s)
- Sunil K Sinha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andreas Barth
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Jack Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gordon Tomaselli
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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