Biffi Mauro, Ziacchi Matteo, Bertini Matteo, Sangiorgi Diego, Corsini Daniela, Martignani Cristian, Diemberger Igor, Boriani Giuseppe
Institute of Cardiology Policlinico S Orsola-Malpighi, University of Bologna, Bologna, Italy.
Europace. 2008 Nov;10(11):1288-95. doi: 10.1093/europace/eun240. Epub 2008 Sep 3.
Comparative studies on the longevity of implantable cardioverter-defibrillators (ICDs) among different manufacturers have never been reported. Longevity of ICD devices implanted from 1 January 2000 to 31 December 2002 was prospectively investigated according to their type and manufacturer.
Longevity of single-chamber (SC), double-chamber (DC), and biventricular (CRT-D) ICDs from Medtronic (MDT), Guidant (GDT), and St Jude Medical (SJM) was measured in all the patients who required device replacement. The observation follow-up ended on 31 December 2007; patients who died prematurely or were transplanted before battery exhaustion were excluded from the analysis. Factors associated with longevity (number of delivered shocks, pacing activity) were researched. One hundred and fifty-three patients received an ICD in the abovementioned period. Six underwent heart transplantation, and 23 died before device replacement; 80 had an SC device, 59 had DC device, and 14 had CRT-D device. Longevity of MDT was superior to GDT and SJM, replacement rates being, respectively, 42%, 95.3%, and 97.2%. Only MDT manufacturers and SC type were associated with greater ICD longevity. Longevity had an impact on the cost/month of treatment of replaced ICDs.
Battery longevity is significantly different among manufacturers. ICD cost is strictly dependent on device longevity, whereas device up-front cost is of limited clinical meaning. Appropriate assessment of cost-effectiveness should be based on ICD longevity in the real-life scenario.
不同制造商的植入式心脏复律除颤器（ICD）寿命的比较研究从未有过报道。对2000年1月1日至2002年12月31日植入的ICD设备的寿命，根据其类型和制造商进行了前瞻性研究。
在所有需要更换设备的患者中，测量了美敦力（MDT）、Guidant（GDT）和圣犹达医疗（SJM）的单腔（SC）、双腔（DC）和双心室（CRT-D）ICD的寿命。观察随访于2007年12月31日结束；分析中排除了过早死亡或在电池耗尽前接受移植的患者。研究了与寿命相关的因素（电击次数、起搏活动）。在上述期间，153名患者接受了ICD植入。6名患者接受了心脏移植，23名患者在设备更换前死亡；80名患者使用SC设备，59名患者使用DC设备，14名患者使用CRT-D设备。MDT的寿命优于GDT和SJM，更换率分别为42%、95.3%和97.2%。只有MDT制造商和SC类型与更长的ICD寿命相关。寿命对更换ICD的每月治疗成本有影响。
不同制造商的电池寿命存在显著差异。ICD成本严格取决于设备寿命，但设备前期成本的临床意义有限。在实际临床场景中，应基于ICD寿命对成本效益进行合理评估。
