title: Battery drain in daily practice and medium-term projections on longevity of cardioverter-defibrillators: an analysis from a remote monitoring database.
abstract: OBJECTIVE
  The longevity of generators is a crucial determinant of the cost-effectiveness of therapy with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). We evaluated the trend of device-measured residual battery capacity and longevity projections over 5-year follow-up. We also investigated possible factors associated with battery drain.
  
  
  RESULTS
  Data from 4851 patients in the European LATITUDE(®) database who were followed up for a minimum of 3 years were analysed. The factors associated with battery drain (i.e. year-to-year decrease in residual battery capacity), and thus potentially impacting on device longevity, were mainly the pacing parameters in CRT-D devices and the number of shocks delivered and diverted in both ICD and CRT-D (all P < 0.01 on linear regression analysis). Over the first 5 years, the longevity estimates provided by devices showed low intra-patient variability and increased with time. The estimates exceeded 10 years for CRT-D and 13 and 12 years for single- and dual-chamber ICDs, respectively. In CRT-D patients, the expected patient age on replacement was 80 ± 12 years, and the expected probability of undergoing device replacement was 63 ± 13% for New York Heart Association (NYHA) II patients and 37 ± 16% for NYHA III patients. For comparison, the probabilities of replacing a CRT-D lasting 5 years were 78 ± 8 and 59 ± 13%, respectively (both P < 0.001).
  
  
  CONCLUSIONS
  Battery drain was mainly associated with pacing output in CRT-D devices and with the number of capacitor charges in both ICD and CRT-D devices. The longevity estimates provided by the devices were consistent and conservative. According to these estimates, among CRT-D recipients a low proportion of patients should require device replacement.
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy Department of Cardiology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy giuseppe.boriani@unimore.it.
authors: Giuseppe
authors: G
authors: Boriani
authors: Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France.
authors: Philippe
authors: P
authors: Ritter
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
authors: Mauro
authors: M
authors: Biffi
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
authors: Matteo
authors: M
authors: Ziacchi
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
authors: Igor
authors: I
authors: Diemberger
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
authors: Cristian
authors: C
authors: Martignani
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
authors: Cinzia
authors: C
authors: Valzania
authors: Boston Scientific Italia, Milan, Italy.
authors: Sergio
authors: S
authors: Valsecchi
authors: University of Florence, Florence, Italy IRCCS MultiMedica, Sesto San Giovanni, Italy.
authors: Luigi
authors: L
authors: Padeletti
authors: Karolinska University Hospital, Stockholm, Sweden.
authors: Fredrik
authors: F
authors: Gadler
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000639:trends; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects / Q000639:trends; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000639:trends; D020878:Device Removal; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000639:trends; D011211:Electric Power Supplies / Q000009:adverse effects / Q000639:trends; D006801:Humans; D016014:Linear Models; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000639:trends; D058998:Remote Sensing Technology / Q000639:trends; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Battery; Cardiac resynchronization therapy; Implantable cardioverter-defibrillator; Longevity; Remote monitoring