Battery drain in daily practice and medium-term projections on longevity of cardioverter-defibrillators: an analysis from a remote monitoring database

Abstract

AimsThe 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 resultsData 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).ConclusionBattery 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.

Performance of Anatomically Designed Quadripolar Left Ventricular Leads: Results from the NAVIGATE X4 Clinical Trial

“…The median pacing threshold at 3 months was 1.0 V for Spiral and 1.2 V for Straight leads. This will provide implanting physicians options to pace closer to the basal region of the left ventricle regardless of patient anatomy and will have a positive effect on CRT‐D longevity, as high LV pacing output has shown to be a strong determinant of increased battery drain and shorter times to elective replacement …”

“Real life” longevity of implantable cardioverter‐defibrillator devices

“…Reducing the frequency of generator replacements would also reduce the frequency of important complications, such as device infection, and their consequent costs . Real‐life longevity is definitely sharply shorter compared with the industry‐projected longevity, which has always overestimated ICD device performance …”

“…Manufacturers of the newer‐generation ICD models promise a 5‐ to 9‐year projected longevity . There have been a few previous studies reporting on the longevity of newer ICD systems that practically refute this industry claim .…”

Significant Discrepancy Between Estimated and Actual Longevity in St. Jude Medical Implantable Cardioverter‐Defibrillators

“…The longevity gauge has been introduced in Boston Scientific ICDs since 2008 and in Medtronic ICDs since 2013, but we did not have enough numbers of patients at our institution whose devices reached ERI to make a meaningful comparison. One study of Boston Scientific devices based on a remote monitoring database reported that the estimated longevity of CRT‐ICDs exceeded 10 years, but these devices were still in service at the end of that study, and it remains to be seen if there is any discrepancy between actual and estimated longevity …”