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.

Limitations

Limitations of this study include the method used to obtain our results. Direct battery measurement with a load attached to the pacemaker was not performed; rather, telemetry measurements collected in the device clinic just prior to generator change were analyzed. Direct battery measurement would provide a more reliable battery longevity assessment. Additionally, since device parameters were collected within 3 months prior to explanation, they may slightly overestimate the true battery life potential.

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Table I. List of the Reasons for Explantation
Indication for Explantation	Useable Devices (n = 135)	Nonuseable Devices (n = 666)	P-Value
ERI	0 (0.0%)	541 (81.2%)	<0.001
Infection	43 (31.9%)	19 (2.4%)	<0.001
Upgrade to ICD	13 (9.6%)	7 (1.0%)	<0.001
Upgrade to CRT-D	27 (20.0%)	33 (5.0%)	<0.001
Upgrade to dual-chamber pacemaker	1 (0.7%)	0 (0.0%)	0.024
Upgrade to CRT-pacemaker	3 (2.2%)	1 (0.1%)	0.002
Heart transplant/LVAD implantation	25 (18.5%)	19 (2.9%)	<0.001
Device failure	0 (0.0%)	16 (2.4%)	0.073
Lead failure	13 (9.6%)	26 (3.9%)	0.004
Device recall	0 (0.0%)	2 (0.3%)	0.529
Patient request	6 (4.4%)	6 (0.9%)	0.002

Devices explanted for reasons of an infection, an upgrade to a different device, a heart transplantation/LVAD implantation, a lead failure, or because the patient no longer wants the device had a battery life ≥48 months. These devices were also free of malfunctions and thus could potentially be reutilized. CRT-D = cardiac resynchronization therapy—defibrillator; ERI = elective replacement indicator; ICD = implantable cardioverter-defibrillator; LVAD = left ventricular assist device.

Table II. Results from a Logistic Regression Analysis, Which Was Used to Determine the Independent Predictors for Devices That Could be Reutilized
Variable	Odds Ratio (OR)	P-Value
Device age (months)	0.929	<0.001
Patient age at explantation	0.998	0.832
Explanted for infection	110	<0.001
Explanted for upgrade to ICD	163	<0.001
Explanted for upgrade to CRT-D	63.8	<0.001
Explanted for heart transplant/LVAD implantation	56.6	<0.001
Patient requested explantation	115	<0.001
Explanted for lead failure	40.6	<0.001
SJM device	0.216	0.012
GDT/BS device	0.251	0.252

Devices explanted for an infection, a device upgrade, heart transplant/LVAD implant, at the request of the patient, or lead failures are overwhelmingly likely to meet the criteria for reuse. St. Jude Medical (SJM) devices were more likely to be reusable. GDT/BS = Guidant/Boston Scientific. Other abbreviations as in Table I.

Table III. List of Patients' Indications for Their ICD/CRT-D
Indication for ICD/CRT-D	Useable ICD/CRT-D (n = 94)	Nonuseable ICD/CRT-D (n = 396)	P-Value
Primary prevention of SCD	73 (77.6%)	268 (67.7%)	0.058
Secondary prevention of SCD	15 (16.0%)	91 (23.0%)	0.224
Other	6 (6.4%)	37 (9.3%)	0.806

Devices from patients with primary prevention indication were more likely to be suitable for reuse. SCD = sudden cardiac death. Other abbreviations as in Table I.

Table IV. List of Patients' Indications for Their Pacemaker
Indication for Pacemaker	Useable Pacemaker (n = 41)	Nonuseable Pacemaker (n = 270)	P-Value
Sick sinus syndrome	16 (39.0%)	99 (36.7%)	0.777
Atrioventricular block	23 (56.1%)	150 (55.6%)	0.999
Syncope	1 (2.4%)	7 (2.6%)	0.715
Carotid sinus hypersensitivity	0 (0.0%)	8 (3.0%)	0.318
Other	1 (2.4%)	6 (2.2%)	0.632