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October 16, 2012Annals of Internal Medicine

Reuse of Explanted, Resterilized Implantable Cardioverter-Defibrillators

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Why the study?

Does the reuse of explanted, resterilized ICDs provide safe and effective therapy in indigent patients with class I indications?

Population

81 indigent persons in India with class I indications for cardiac resynchronization therapy with an ICD who…

Design

Cohort

Follow-up

mean 824.9 days

Authors

BPBehzad B. PavriElectrophysiologyYLYash LokhandwalaElectrophysiologyGKGaurav KulkarniUnited Lincolnshire Hospitals NHS Trust

Discussion

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Implication

May support resterilized ICD reuse in resource-limited settings; hypothesis-generating and requires randomized trials before practice change.

Structured PICO

Does the reuse of explanted, resterilized ICDs provide safe and effective therapy in indigent patients with class I indications?

P
Population
81 indigent persons in India with class I indications for cardiac resynchronization therapy with an ICD who were unable to afford a device. Mean age 52.6 years, 66 male patients.
I
Intervention
Explanted, resterilized implantable cardioverter-defibrillators (ICDs) with 3 or more years of estimated remaining battery life
O
Outcome
Device longevity after reimplantation, device-related complications, number of appropriate therapies, patient clinical characteristics, and deaths

Explanted, resterilized ICDs can be safely reused in indigent patients, providing life-saving therapies without an increased risk of infectious complications.

Limitations

  • Retrospective report of a single-center experience with a modest number of patients and devices
  • Follow-up data were missing for 6 patients
  • No records were kept of the number of devices obtained through postmortem versus antemortem explantation or whether explantation was due to infection or upgrade
  • Complete data were not available on exact battery voltage at the time of reimplantation, left ventricular ejection fraction, or number of inappropriate shocks
  • A control group was not possible

Cite This Study

Pavri et al. (2012) studied this question.

synapsesocial.com/papers/6a72da5c52863cde50543980https://doi.org/10.7326/0003-4819-157-8-201210160-00004

Topics

Cardiac device therapy
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Re-used pacemakers—as safe as new? A retrospective case-control study1998 · 63 citations
  2. 2Impact of advanced age on survival in patients with implantable cardioverter defibrillators2008 · 51 citations
  3. 3A prospective audit of pacemaker function, implant lifetime, and cause of death in the patient.1999 · 14 citations
  4. 4Safety, Efficacy, and Performance of Implanted Recycled Cardiac Rhythm Management (CRM) Devices in Underprivileged Patients2011 · 23 citations