Device Longevity in a Contemporary Cohort of ICD/CRT-D Patients Undergoing Device Replacement.
The longevity of defibrillators (ICD) is extremely important from both a clinical and economic perspective. We studied the reasons for device replacement, the longevity of removed ICD, and the existence of possible factors associated with shorter service life.



Consecutive patients who underwent ICD replacement from March 2013 to May 2015 in 36 Italian centers were included in this analysis. Data on replaced devices were collected. A total of 953 patients were included in this analysis. In 813 (85%) patients the reason for replacement was battery depletion, while 88 (9%) devices were removed for clinical reasons and the remaining 52 because of system failure (i.e., lead or ICD generator failure or a safety advisory indication). The median service life was 5.9 years (25th-75th percentile, 4.9-6.9) for single- and dual-chamber ICD and 4.9 years (25th-75th percentile, 4.0-5.7) for CRT-D. On multivariate analysis, the factors CRT-D device, SC/DC ICD generator from Biotronik, percentage of ventricular pacing, and the occurrence of a system failure were positively associated with a replacement procedure. By contrast, the device from Boston Scientific was an independent protective factor against replacement. Considerable differences were seen in battery duration in both ICD and CRT-D. Specifically, Biotronik devices showed the shortest longevity among ICD and Boston Scientific showed the longest longevity among CRT-D (log-rank test, P < 0.001 for pairwise comparisons).



Several factors were associated with shorter service life of ICD devices: CRT-D, occurrence of system failure and percentage of ventricular pacing. Our results confirmed significant differences among manufacturers.
Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
Francesco
F
Zanon
Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
Cristian
C
Martignani
Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
Ernesto
E
Ammendola
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Endrj
E
Menardi
Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
Maria Lucia
ML
Narducci
Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
Paolo
P
DE Filippo
Cardiovascular and Arrhythmias Department, Giovanni Paolo II Research & Care Foundation, Campobasso, Italy.
Matteo
M
Santamaria
Medical-Surgical Department of Cardiology, Azienda Ospedaliera "Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
Andrea
A
Campana
Clinica Mediterranea, Naples, Italy.
Giuseppe
G
Stabile
Department of Cardiology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
Domenico Rosario
DR
Potenza
Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
Gianni
G
Pastore
Unit of Cardiac Surgery Department of Cardiology Thoracic and Vascular Surgery and Critical Care Medicine, Azienda Ospedaliera ASMN Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
Matteo
M
Iori
Villa Verde Hospital, Taranto, Italy.
Concetto
C
LA Rosa
Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
Mauro
M
Biffi
D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D020878:Device Removal; D004554:Electric Countershock / Q000295:instrumentation*; D011211:Electric Power Supplies; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D013997:Time Factors
Battery; CRT; implantable defibrillator; longevity