title: Cardiac implantable electronic device reutilization: battery life of explanted devices at a tertiary care center.
abstract: BACKGROUND
  Prior studies have suggested that pacemaker reuse may be a reasonable alternative to provide device therapy in the low- and middle-income countries. We studied explant indications and remaining battery life of cardiac implantable electronic devices (CIEDs) at a tertiary medical center.
  
  
  RESULTS
  We conducted a retrospective review of all CIEDs extracted at the University of Michigan between 2007 and 2011. Devices were considered reusable if battery longevity was ≥48 months or >75% battery life was remaining; there was no evidence of electrical malfunction, and they were not under advisory or recall. Eight hundred and one CIEDs were explanted: Medtronic (MDT [Medtronic Inc., Minneapolis, MN, USA]; 454), Boston Scientific (BS [Boston Scientific Corp., Natick, MA, USA])/Guidant (GDT; 255 [Guidant Corp., St. Paul, MN, USA]), St. Jude Medical (SJM; 73 [St. Paul, MN, USA]), and Biotronik (BTK; 15 [Biotronik GmBH, Berlin, Germany]). After eliminating devices explanted for elective replacement indicator (ERI, 541), 51.9% of pacemakers (41/79), 54.2% of implantable cardioverter-defibrillators (ICDs) (64/118), and 47.6% of cardiac resynchronization therapy and defibrillation (CRT-D) devices (30/63) had sufficient battery life and no evidence of electrical malfunction to be considered for reuse. A logistic regression analysis found that the indications for device removal independently predicted reusability: upgrade to an ICD (odds ratio [OR] 162.8, P < 0.001) or CRT-D (OR 63.8, P < 0.001), infection (OR 110.7, P < 0.001), heart transplantation or left ventricular assist device placement (OR 56.6, P < 0.001), and device removal at patient's request (OR 115.4, P < 0.001).
  
  
  CONCLUSIONS
  The majority of explanted CIEDs for reasons other than ERI have an adequate battery life and, if proven safe, may conceivably be reutilized for basic pacing in underserved nations where access to this life-saving therapy is limited.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Gakenheimer
authors.forename: Joshua
authors.initials: J
authors.lastname: Romero
authors.forename: Timir S
authors.initials: TS
authors.lastname: Baman
authors.forename: Dan
authors.initials: D
authors.lastname: Montgomery
authors.forename: Cydni A
authors.initials: CA
authors.lastname: Smith
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
mesh_terms: D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000706:statistics & numerical data*; D011211:Electric Power Supplies / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D017743:Equipment Reuse / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: defibrillation - ICD; pacing