Automatic adjustment of stimulation output in resynchronization therapy: impact and effectiveness in clinical practice

Pierantozzi, Attilio; Landolina, Maurizio; Agricola, Tullio; Lunati, Maurizio; Pisanò, E; Lonardi, G.; Bardelli, G.; Proclemer, Alessandro; Speca, Giancarlo; Zucchi, Giovanna; Marseglia, Alessio; Valsecchi, Sergio; Bocconcelli, Paolo

doi:10.1093/europace/eur118

Cited by 7 publications

(2 citation statements)

References 19 publications

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“…The majority of the recent Medtronic CRT-Ds was endowed with algorithms for automatic pacing output adjustment, which have been demonstrated to reduce pacing output in comparison with the standard manual management approach. 17 This may have determined the observed improvement in longevity.…”

Section: Discussionmentioning

confidence: 99%

Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer

et al. 2015

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AimsDevice 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 resultsWe 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.ConclusionThe 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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Section: Discussionmentioning

confidence: 99%

Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer

et al. 2015

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“…Nonetheless, although published results may not fully apply to newer devices, specific battery characteristics, i.e. cell capacity, 14 lithium manganese dioxide chemistry, 7 or algorithms for the optimization of pacing output 15 were shown to improve longevity and should therefore be considered at the time of device selection.…”

Section: Discussionmentioning

confidence: 99%

The economic impact of battery longevity in implantable cardioverter-defibrillators for cardiac resynchronization therapy: the hospital and healthcare system perspectives

et al. 2016

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AimsPatients receiving cardiac resynchronization therapy defibrillators (CRT-Ds) are likely to undergo one or more device replacements, mainly for battery depletion. We assessed the economic impact of battery depletion on the overall cost of CRT-D treatment from the perspectives of the healthcare system and the hospital. We also compared devices of different generations and from different manufacturers in terms of therapy cost.Methods and resultsWe analysed data on 1792 CRT-Ds implanted in 1399 patients in 9 Italian centres. We calculated the replacement probability and the total therapy cost over 6 years, stratified by device generation and manufacturer. Public tariffs from diagnosis-related groups were used together with device prices and hospitalization costs. Generators were from 3 manufacturers: Boston Scientific (667, 37%), Medtronic (973, 54%), and St Jude Medical (152, 9%). The replacement probability at 6 years was 83 and 68% for earlier- and recent-generation devices, respectively. The need for replacement increased total therapy costs by more than 50% over the initial implantation cost for hospitals and by more than 30% for healthcare system. The improved longevity of recent-generation CRT-Ds reduced the therapy cost by ∼6% in both perspectives. Among recent-generation CRT-Ds, the replacement probability of devices from different manufacturers ranged from 12 to 70%. Consequently, the maximum difference in therapy cost between manufacturers was 40% for hospitals and 19% for the healthcare system.ConclusionsDifferences in CRT-D longevity strongly affect the overall therapy cost. While the use of recent-generation devices has reduced the cost, significant differences exist among currently available systems.

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Estimate and reporting of longevity for cardiac implantable electronic devices: a proposal for standardized criteria

Censi¹,

Mattei²,

Ricci³

et al. 2021

Expert Review of Medical Devices

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Automatic adjustment of stimulation output in resynchronization therapy: impact and effectiveness in clinical practice

Cited by 7 publications

References 19 publications

Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer

Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer

The economic impact of battery longevity in implantable cardioverter-defibrillators for cardiac resynchronization therapy: the hospital and healthcare system perspectives

Estimate and reporting of longevity for cardiac implantable electronic devices: a proposal for standardized criteria

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