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

Abstract

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.

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

“…Assuming a median CRT-D battery life of 5 years 6 and an incidence rate of 5 SCD per 1,000 patient-years in CRT-D and 20 in CRT-P, after computing the cumulative incidence of the event we calculated a patient-based NNT of 13.5 per battery life, or an annual NNT of 67.5. These represent the number of CRT patients who would need an ICD for one SCD to be prevented during the battery-life or a 12-month period, respectively.…”

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

“…Previous studies have shown that ICD and CRT-D longevity may vary significantly between manufacturers, 3–5 thus impacting on healthcare costs. 6 However, currently available data refer to heterogeneous populations, cardiac devices, and time periods.…”

Economic impact of longer battery life of cardiac resynchronization therapy defibrillators in Sweden

“…Data on CRT-D battery survival were obtained from a previously published report by Landolina et al22 Data on all patients who had received a CRT-D system between 2008 and 2010 according to international recommendations were prospectively collected in the hospital databases of nine Italian implanting centers. The comparison of longevity among recent-generation CRT-Ds from different manufacturers (e.g., Boston Scientific Corporation [BSC], St. Jude Medical [SJM] and Medtronic [MDT]) was performed only for subgroups with at least 100 devices in the analysis.…”

“…The comparison of longevity among recent-generation CRT-Ds from different manufacturers (e.g., Boston Scientific Corporation [BSC], St. Jude Medical [SJM] and Medtronic [MDT]) was performed only for subgroups with at least 100 devices in the analysis. Recent-generation devices were identified as the most recent device families released onto the market, for the most part after 2007 22. The results from the study by Landolina et al22 showed that recent-generation BSC CRT-D devices have substantially longer battery life than CRT-D devices from the other two manufacturers, SJM and MDT.…”

“…A recent economic study conducted from a general European hospital perspective reported a total potential saving of 29–34% over a 15-year period by extending device longevity from 4–5 years to 7–9 years 25. Therefore, device longevity and real-world battery life are crucial considerations when selecting a CRT-D device for patients – for the welfare of not only the patients themselves but also their health care payers 15,22…”