title: Performance of re-used pacemakers and implantable cardioverter defibrillators compared with new devices at Groote Schuur Hospital in Cape Town, South Africa.
abstract: OBJECTIVE
  Little is known about the performance of re-used pacemakers and implantable cardioverter defibrillators (ICDs) in Africa. We sought to compare the risk of infection and the rate of malfunction of re-used pacemakers and ICDs with new devices implanted at Groote Schuur Hospital in Cape Town, South Africa.
  
  
  METHODS
  This was a retrospective case comparison study of the performance of re-used pacemakers and ICDs in comparison with new devices implanted at Groote Schuur Hospital over a 10-year period. The outcomes were incidence of device infection, device malfunction, early battery depletion, and device removal due to infection, malfunction, or early battery depletion.
  
  
  RESULTS
  Data for 126 devices implanted in 126 patients between 2003 and 2013 were analysed, of which 102 (81%) were pacemakers (51 re-used and 51 new) and 24 (19%) were ICDs (12 re-used and 12 new). There was no device infection, malfunction, early battery depletion or device removal in either the re-used or new pacemaker groups over the median follow up of 15.1 months [interquartile range (IQR), 1.3-36.24 months] for the re-used pacemakers, and 55.8 months (IQR, 20.3-77.8 months) for the new pacemakers. In the ICD group, no device infection occurred over a median follow up of 35.9 months (IQR, 17.0-70.9 months) for the re-used ICDs and 45.7 months (IQR, 37.6-53.7 months) for the new ICDs. One device delivered inappropriate shocks, which resolved without intervention and with no harm to the patient. This re-used ICD subsequently needed generator replacement 14 months later. In both the pacemaker and ICD groups, there were no procedure-non-related infections documented for the respective follow-up periods.
  
  
  CONCLUSIONS
  No significant differences were found in performance between re-used and new pacemakers and ICDs with regard to infection rates, device malfunction, battery life and device removal for complications. Pacemaker and ICD re-use is feasible and safe and is a viable option for patients with bradyarrhythmias and tachyarrthythmias.
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa. zvjama@gmail.com.
authors.forename: Zimasa V
authors.initials: ZV
authors.lastname: Jama
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Ashley
authors.initials: A
authors.lastname: Chin
authors.affiliation: College of Medicine, King Saudi Bin, Abdulaziz University for Medical Sciences, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Motasim
authors.initials: M
authors.lastname: Badri
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D020878:Device Removal; D011211:Electric Power Supplies; D004868:Equipment Failure / Q000706:statistics & numerical data*; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D013019:South Africa