May 14, 2015EP Europace47 citationsOpen Access

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

MLMaurizio LandolinaAzienda Ospedaliera Ospedale Maggiore ACAntonio CurnisAzienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia GMGiovanni MoraniCTO Hospital

Structured PICO

Do device manufacturer, generation, and pacing configuration affect the rate of battery depletion in patients with CRT-D devices?

Population

n=1726 consecutive patients who had undergone implantation of CRT-D devices from January 2008 to March 2010 in nine centres.

Intervention

Implantation of Cardiac resynchronization therapy defibrillators (CRT-D)

Comparator

Different CRT-D manufacturers, device generations, and pacing configurations (unipolar vs bipolar, high vs low left ventricular lead output)

Outcome

Rate of device replacements for battery depletion at 5 years

CRT-D device longevity at 5 years is approximately 54%, with significant variations based on manufacturer, device generation, LV lead output, and pacing configuration.

Abstract

AIMS: Device 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 RESULTS: We 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. CONCLUSION: The 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.

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