Open AccessImpact of pacemaker longevity on expected device replacement rates: Results from computer simulations based on a multicenter registry (ESSENTIAL)
Author(s) -
Boriani Giuseppe,
Bertini Matteo,
Saporito Davide,
Belotti Giuseppina,
Quartieri Fabio,
Tomasi Corrado,
Pucci Angelo,
Boggian Giulio,
Mazzocca Gian Franco,
Giorgi Davide,
Diotallevi Paolo,
Sassone Biagio,
Grassini Diego,
Gargaro Alessio,
Biffi Mauro
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23003
Subject(s) - medicine , longevity , bradycardia , sick sinus syndrome , cardiology , cohort , atrial fibrillation , sinus rhythm , heart rate , surgery , gerontology , blood pressure
Background The rate of device replacement in pacemaker recipients has not been investigated in detail. Hypothesis Current pacemakers with automatic management of atrial and ventricular pacing output provide sufficient longevity to minimize replacement rate. Methods We considered a cohort of 542 pacemaker patients (age 78 ± 9 years, 60% male, 71% de‐novo implants) and combined 1‐month projected device longevity with survival data and late complication rate in a 3‐state Markov model tested in several Monte Carlo computer simulations. Predetermined subgroups were: age < or ≥ 70; gender; primary indication to cardiac pacing. Results At the 1‐month follow‐up the reported projected device longevity was 153 ± 45 months. With these values the proportion of patients expected to undergo a device replacement due to battery depletion was higher in patients aged <70 (49.9%, range 32.1%‐61.9%) than in age ≥70 (24.5%, range 19.9%‐28.8%); in women (39.9%, range 30.8%‐48.1%) than in men (32.0%, range 24.7%‐37.5%); in sinus node dysfunction (41.5%, range 30.2%‐53.0%) than in atrio‐ventricular block (33.5%, range 27.1‐38.8%) or atrial fibrillation with bradycardia (27.9%, range 18.5%‐37.0%). The expected replacement rate was inversely related to the assumed device longevity and depended on age class: a 50% increase in battery longevity implied a 5% reduction of replacement rates in patients aged ≥80. Conclusions With current device technology 1/4 of pacemaker recipients aged ≥70 are expected to receive a second device in their life. Replacement rate depends on age, gender, and primary indication owing to differences in patients' survival expectancy. Additional improvements in device service time may modestly impact expected replacement rates especially in patients ≥80 years.