The short battery life of cardiac devices, such as pacemakers and implantable cardioverter defibrillators (ICDs), is a “scandal,” two cardiologists argued.
A depleted device leads to replacement procedures and the increased odds of infection that go along with them, so it is “critical that we prolong the life of implantable devices as much as possible,” John Dean, MD, of Royal Devon and Exeter Hospital, and Neil Sulke, MD, of Eastbourne Hospital, both in the U.K., wrote online in BMJ.
Faisal M. Merchant, MD, of Emory Healthcare in Atlanta, agreed, telling MedPage Today in a telephone interview that “the more times you change the battery, the more the patient is exposed to risks such as infection. And the risk is cumulative, so every time you do it, the risk goes up a little more.”
He added that the problem with pacemakers and ICDs today is that “the battery technology is not there the way it is for other devices, like cell phones.”
Device manufacturers may have had a hand in that, according to Dean and Sulke. “The current financial model discourages the development of longer life devices. Increasing longevity would reduce profits for manufacturers, implanting physicians, and their institutions,” they explained, suggesting why “it is hardly surprising that longer life devices do not exist.”
However, “I don’t know that the financial incentives are so misaligned that it’s a scandal,” Merchant countered. “It implies that there’s some sort of collusion on the part of the device companies. There may be some truth to that, but if a manufacturer came out with a device with a longer battery life that would actually give them a market advantage.”
In any case, the bottom line is that “there is an urgent need to minimize the requirement for replacement of these devices. Doing so will save lives, minimize suffering, and reduce costs,” Dean and Sulke wrote.
To that end, the pair suggested that clinicians “delay replacement of the pulse generator until the batteries are virtually depleted in lower risk patients,” given that “devices are usually replaced when there is still substantial life left in the battery.”
“When a pacemaker reaches elective replacement indication, it is usually 3-12 months before it will reach the end of life. And even then, the battery may continue to function for several months,” they reasoned, acknowledging, however, that patients who are “entirely dependent” on their devices are a different story.
“Pacer-dependent patients or those requiring cardiac resynchronization therapy may need earlier replacement, as would patients with frequent ventricular arrhythmias,” agreed Michael R. Gold, MD, PhD, of Medical University of South Carolina in Charleston, in an email to MedPage Today.
“There’s something to be gained by not being so aggressive in changing the device,” Merchant said.
Dean and Sulke also suggested that patients would prefer a longer battery life — even if it came in a larger device — though Merchant was not sold on the idea. “The larger the device, the higher the risk of infection when you have to do something to it later. It’s hard to know where the sweet spot lies with respect to size,” he said.
Better yet is to remember that “there are ways to program the device so its outputs are not so necessarily high. Those programming strategies are important — focusing on them is really key and is what we can do for now,” Merchant emphasized.
Additionally, operators can “put pressure on the device industry to move towards adopting new technologies” that will maximize battery life, according to Samir F. Saba, MD, of the University of Pittsburgh Medical Center.
Mark J. Dayer, PhD of England’s Musgrove Park Hospital, noted in an online editorial that although “the differences [between devices] are there to see in the manufacturers’ product performance reports,” they are rarely read by cardiologists due to “the dense nature of the texts.”
That’s why “choosing the device that has a better longevity track record” is another step that clinicians can take today, Saba toldMedPage Today, and another opportunity to improve patient outcomes.
Dean, Sulke, and Merchant reported no relevant conflicts of interest.
Saba reported receiving research support from Medtronic, Boston Scientific, and St. Jude Medical.
Dayer disclosed relationships with Medtronic, Boston Scientific, St. Jude Medical, Biotronik, and Sorin (LivaNova).
Gold reported consulting for Boston Scientific, Medtronic, and St. Jude Medical.
Dean J and Sulke N et al “Pacemaker battery scandal” BMJ 2016; DOI: 10.1136/bmj.i228