Why Are Implantable Cardioverter-Defibrillators and Pacemakers Being Revised Today?

摘要

Utilization of cardiac implantable electronic devices (CIEDs), including both pacemakers (PM) and implantable cardioverter-defibrillators (ICDs), has dramatically increased in recent years. Re-use of CIEDs could potentially provide financial savings to the healthcare system or make CIEDs available to patients who cannot afford them. The re-use of CIEDs has not been systematically studied. In addition, the number of CIED-related infections is increasing. This study focuses on retrieval analysis of implantable PM and ICDs. In a 19-month period, a consecutive series of 184 devices (112 ICDs and 72 PMs) were collected as part of an IRB-approved device retrieval program. The main reason for removal of ICDs and PMs was elective device replacement due to battery depletion indicated by ERI battery voltage. There was no direct correlation seen between implantation time and remaining battery voltage for both device types. For ICDs, removal reason (ERI), patient age (interval 40-50 years old) and number of leads (one or two) were found to affect implantation time. The removal reason and the number of leads (two or three) were a significant factor in the amount of remaining battery voltage for ICDs. Several patient factors and device parameter settings (ex: percent pacing, programmed pulse amplitude and duration) influenced the implantation time, remaining battery voltage and reason for removal. Increasing number of leads or patient reliance on the device caused the battery drain to increase and implantation time to decrease. Energy-dispersive X-ray spectroscopy (EDS) showed that all six randomly chosen devices had biological residue. The number of CIED-related infections are increasing and becoming a large clinical problem that should be the focus of future studies. More retrieval programs or multiple sites should be set up for larger scale analysis of CIEDS.