Clinical Research in Cardiology

, Volume 102, Issue 1, pp 43–49

Significant differences in the expected versus observed longevity of implantable cardioverter defibrillators (ICDs)

  • Tali Shafat
  • Yael Baumfeld
  • Victor Novack
  • Yuval Konstantino
  • Guy Amit
Original Paper

DOI: 10.1007/s00392-012-0493-6

Cite this article as:
Shafat, T., Baumfeld, Y., Novack, V. et al. Clin Res Cardiol (2013) 102: 43. doi:10.1007/s00392-012-0493-6

Abstract

Background

Implantable cardioverter defibrillator (ICD) is a life-saving therapy for patients at risk of ventricular arrhythmias. Due to its high cost, its cost-effectiveness is highly dependent on its longevity, which is currently only based upon the manufacturer’s predicted device life span.

Aim

We sought to assess the ICDs’ longevity and the factors influencing it, and to compare the observed (real life) to the expected (manufacturer’s prediction) life span at a device level.

Methods

We retrospectively identified all patients who underwent an ICD implantation in a tertiary care medical center. For each device, an expected longevity was assigned based on the manufacturer/model, pacing percentage, and number of shocks per year. We defined device failure if the observed survival was shorter than 80 % of the expected. Only devices with follow-up time that exceeded the expected longevity were included.

Results

Of the 275 devices in the cohort, 79 (29 %) failed. Median device longevity was 5 years and varied markedly between manufacturers (4.3, 4.8, 5.1, and 6.3 years for Biotronik, St. Jude Medical, Boston Scientific, and Medtronic, respectively). There were significant differences among the manufacturers in device failure rates: 48, 17, 22, and 14 % for Biotronik, St. Jude Medical, Boston Scientific, and Medtronic, respectively). In multivariate analysis, manufacturer, earlier year of implantation, congestive heart failure and chronic renal failure significantly predicted device failure.

Conclusions

In conclusion, there is a significant device failure rate among ICDs, with variability among manufacturers, impacting both patients and the medical economic systems.

Keywords

Implantable cardioverter defibrillatorDevice failureLongevityBattery performance

Abbreviations

ICD

Implantable cardioverter defibrillator

VVI

Single chamber ICD

DDD

Dual chamber ICD

CRT

Cardiac resynchronization therapy bi-ventricular ICD

ERI

Elective replacement indication

QALY

Quality-adjusted life-years

Supplementary material

392_2012_493_MOESM1_ESM.doc (54 kb)
Supplementary material 1 (DOC 54 kb)

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Tali Shafat
    • 1
    • 2
    • 3
  • Yael Baumfeld
    • 2
    • 3
  • Victor Novack
    • 2
    • 3
  • Yuval Konstantino
    • 1
    • 3
  • Guy Amit
    • 1
    • 3
  1. 1.Department of CardiologySoroka University Medical CenterBeer-ShevaIsrael
  2. 2.Clinical Research CenterSoroka University Medical CenterBeer-ShevaIsrael
  3. 3.Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael