Cardiac Implantable Electronic Device Reutilization

Battery Life of Explanted Devices at a Tertiary Care Center

Lindsey Gakenheimer, B.S.; Joshua Romero, M.D.; Timir S. Baman, M.D.; Dan Montgomery, B.S.; Cydni A. Smith, B.A.; Hakan Oral, M.D.; Kim A. Eagle, M.D.; Thomas Crawford, M.D.

Disclosures

Pacing Clin Electrophysiol. 2014;37(5):569-575. 

In This Article

Abstract and Introduction

Abstract

Introduction: Prior studies have suggested that pacemaker reuse may be a reasonable alternative to provide device therapy in the low- and middle-income countries. We studied explant indications and remaining battery life of cardiac implantable electronic devices (CIEDs) at a tertiary medical center.

Methods and Results: We conducted a retrospective review of all CIEDs extracted at the University of Michigan between 2007 and 2011. Devices were considered reusable if battery longevity was ≥48 months or >75% battery life was remaining; there was no evidence of electrical malfunction, and they were not under advisory or recall. Eight hundred and one CIEDs were explanted: Medtronic (MDT [Medtronic Inc., Minneapolis, MN, USA]; 454), Boston Scientific (BS [Boston Scientific Corp., Natick, MA, USA])/Guidant (GDT; 255 [Guidant Corp., St. Paul, MN, USA]), St. Jude Medical (SJM; 73 [St. Paul, MN, USA]), and Biotronik (BTK; 15 [Biotronik GmBH, Berlin, Germany]). After eliminating devices explanted for elective replacement indicator (ERI, 541), 51.9% of pacemakers (41/79), 54.2% of implantable cardioverter-defibrillators (ICDs) (64/118), and 47.6% of cardiac resynchronization therapy and defibrillation (CRT-D) devices (30/63) had sufficient battery life and no evidence of electrical malfunction to be considered for reuse. A logistic regression analysis found that the indications for device removal independently predicted reusability: upgrade to an ICD (odds ratio [OR] 162.8, P < 0.001) or CRT-D (OR 63.8, P < 0.001), infection (OR 110.7, P < 0.001), heart transplantation or left ventricular assist device placement (OR 56.6, P < 0.001), and device removal at patient's request (OR 115.4, P < 0.001).

Conclusion: The majority of explanted CIEDs for reasons other than ERI have an adequate battery life and, if proven safe, may conceivably be reutilized for basic pacing in underserved nations where access to this life-saving therapy is limited.

Introduction

Pacemaker and implantable cardioverter-defibrillator (ICD) use has been shown to reduce morbidity and mortality in select patients with cardiovascular disease.[1,2] Cardiovascular disease is not only the leading cause of death in the high-income countries, but also in the developing world, where it causes twice as many deaths as human immunodeficiency virus (HIV), malaria, and tuberculosis combined.[3] In some low- and middle-income countries (LMIC), infectious diseases such as Chagas or African Sleeping Sickness add to the bradyarrhythmia burden.[4,5] Unfortunately, cost barriers prevent many patients in the developing countries from benefiting from cardiac implantable electronic devices (CIEDs). The pacemaker and defibrillator implantation rates are dramatically lower in LMIC. For instance, in 2009, Peru and Bangladesh had implantation rates of 30 and five pacemakers per million people, respectively, compared with 767 implants per million population in the United States and 782 in France.[6] The low implantation rates in LMIC reflect poor access to electrophysiological care due to a host of factors, one being the economic conditions.

CIED reutilization has been proposed as a means to eliminate the disparity in pacemaker therapy between the industrialized world and LMIC.[7] This study explores the potential of harvesting "good" devices at the time of CIED removal for clinical indications. We examined the reasons for explantation as well as the remaining battery life of CIEDs explanted at a tertiary medical center. Any device with an adequate battery life and free from known malfunction could potentially be reutilized in LMIC patients who otherwise may not have access to this potentially life-saving therapy.

processing....