Reimplanting Previously Infected Device in the Same Patient: A Clever Way to Provide Essential Therapy

Since the introduction of pacing, and subsequently defibrillation, cardiac rhythm management devices (CRMDs) have brought the improvement in quality of life as well as extended longevity of patients with sick sinus syndrome, complete heart block, and life-threatening ventricular arrhythmias. Unfortunately, despite decades of widespread use, the benefits of CRMDs do not reach all patients who need them. There remains a great disparity in access to this essential therapy between patients in the advanced economies and lowand middle-income countries, largely due to high cost.1 In order to improve access to pacemakers and defibrillators in underserved nations, organizations such as My Heart Your Heart, Pace4Life, and many others have partnered with the funeral and crematory industry to harvest CRDMs postmortem for their potential reuse.2 Funeral home director surveys and patient/general population surveys indicate support for this concept.3 Over the years, many single center and mostly uncontrolled and retrospective studies have suggested that pacemaker reuse may be safe and effective, offering patients a therapeutic option they are otherwise denied due to lack of insurance and/or resources.4 Recent publications have added to the body of evidence that CRMDs may be safely reimplanted. Kantharia et al.5 have reported on a retrospective cohort of 53 patients who received postmortem refurbished pacemakers in Mumbai, India. No infections or device-related failures occurred over mean followup of 21 months. Ninety-five percent of patients reported marked improvement in their symptoms. In another report, Pavri et al.6 described a consecutive series of 81 patients who underwent implantation of 106 implantable cardioverter defibrillators obtained either postmortem or during device upgrades. No infectious complications occurred during a mean follow-up of 825 days,