Projected longevities of cardiac implantable defibrillators: a retrospective analysis over the period 2007–17 and the impact of technological factors in determining longevity

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.

Advances in Cardiac Resynchronization and Implantable cardioverter/defibrillator Therapy: Medtronic Cobalt and Crome

“…Costs play an ever more important role in a healthcare landscape of economic constraints and the associated need for therapies to demonstrate value for money [7]. Increased battery life means fewer generator replacements thereby improving the cost-efficacy of the therapy on individual and population levels.…”

“…It is a particularly important consideration with CRT and ICD devices, which have shorter battery life spans than pacemakers, at the same time as a higher upfront cost [7]. Enhanced longevity can avoid the difficult decision associated with generator replacement in people whose LV function has improved [8], and also reduce the risks of infection and lead damage or failure from routine replacement [7,[9][10][11], thereby lowering considerably the cost of ICD therapy in a population. Moreover, novel algorithms and therapies that reduce complications and hospitalization rates can offset increased upfront costs of device therapy.…”

“…We have recently shown that the estimates of battery drain are more complicated for CRT-D devices than for ICDs: core background functions are responsible for only around 50% of energy use in CRTs compared with more than 90% for ICDs [7]. Nevertheless even with ICDs there are opportunities.…”

“…Finally, as discussed, the background activity of the device is a major contributor to longevity. Reducing current drain can therefore have significant benefits [7,13]. The new Cobalt/Crome heart device portfolio from Medtronic uses high-density integrated circuitry to achieve approximately 9% reduction of the static current drain compared with predecessors [12].…”

Ultrasound-driven triboelectric and piezoelectric nanogenerators in biomedical application

“…In 2006, the world's first piezoelectric nanogenerator (PENG) based on a ZnO nanowire array was invented [33,36]. This innovation generates an electric field through piezoelectric polarization, inducing electron movement and converting mechanical energy into electricity [37,38]. Ultrasound-driven PENGs find utility in energy harvesting, sensors, wearables, and medical implants.…”