Discrepancies in CRT-ICD battery longevity


An independent study demonstrates significant differences in battery longevity between contemporary cardiac resynchronisation therapy (CRT) implantable cardioverter defibrillators (ICDs). The results, published in Europace, show that Boston Scientific and St Jude Medical devices had longer battery life compared with Medtronic devices.

“Cardiac resynchronisation therapy-ICD pulse generator replacement is an invasive procedure with the potential risks of infection, bleeding and damage to the implanted leads. It is an expensive procedure, which along with the cost of a new device contributes to rising healthcare costs. Minimising the frequency of CRT-ICD replacement for battery depletion is therefore desirable for both patients and the healthcare system as a whole,” write Mian Bilal Alam (Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, USA) and colleagues.

Due to the lack of independent “head-to-head” comparisons for battery longevity for CRT-ICDs from various manufacturers, the researchers set out to investigate the battery performance of CRT-ICDs from Boston Scientific, Medtronic and St Jude Medical implanted at their institution.

Between 1 January 2008 and 31 December 2010, 646 patients (mean age 69±13 years, 74% men) who were implanted with current models of CRT-ICDs-Boston Scientific (173), Medtronic (416) and St Jude Medical (57)-were included in this retrospective, observational study. The primary endpoints were the rate of battery depletion reaching elective replacement indicator and the time from device implantation to battery depletion as specified by device manufacturer.

After a mean follow-up of 2.7+/-1.5 years, 113 (17%) devices had reached elective replacement indicator, from those 4% Boston Scientific devices, 7% were St Jude Medical devices and 25% were Medtronic devices (p<0.001). The results also show that the four-year battery survival rate of the Boston Scientific devices was 94%, 92% for St Jude Medical devices and 67% for Medtronic devices (p<0.001).

Alam et al also highlight that “the difference in battery longevity by manufacturer was independent of pacing burden, lead parameters in each chamber (except for left ventricular lead output), and burden of ICD therapy.” They found that after adjusting for these covariates in a multivariate Cox model, Medtronic devices remained more likely to reach the elective replacement indicator compared with the devices from the other two manufacturers.

“Improving device longevity across the whole industry should be an important goal. Achieving this goal may be facilitated by creating a system of financial reward for manufacturers, who provide devices with better battery longevity and conversely a system of financial penalty for those whit lesser battery performance,” noted the authors.

They said that other large, independent, cohorts of patients at other institutions should be required to confirm these findings.

Samir Saba, (associate professor of Medicine and associate professor in Clinical and Translational Science, director, Cardiac Electrophysiology, University of Pittsburgh Medical Center) lead author of the study, told Cardiac Rhythm News: “Battery longevity is inversely linked to the frequency of invasive procedures performed on patients and to the overall risk of complications associated with these invasive procedures. Because of these important implications, the medical community should start paying closer attention to independent data comparing device performance across the industry“.

This study was sponsored exclusively by University of Pittsburgh Medical Center.