Gakenheimer Lindsey, Romero Joshua, Baman Timir S, Montgomery Dan, Smith Cydni A, Oral Hakan, Eagle Kim A, Crawford Thomas
Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
Pacing Clin Electrophysiol. 2014 May;37(5):569-75. doi: 10.1111/pace.12321. Epub 2013 Dec 20.
Prior studies have suggested that pacemaker reuse may be a reasonable alternative to provide device therapy in the low- and middle-income countries. We studied explant indications and remaining battery life of cardiac implantable electronic devices (CIEDs) at a tertiary medical center.
We conducted a retrospective review of all CIEDs extracted at the University of Michigan between 2007 and 2011. Devices were considered reusable if battery longevity was ≥48 months or >75% battery life was remaining; there was no evidence of electrical malfunction, and they were not under advisory or recall. Eight hundred and one CIEDs were explanted: Medtronic (MDT [Medtronic Inc., Minneapolis, MN, USA]; 454), Boston Scientific (BS [Boston Scientific Corp., Natick, MA, USA])/Guidant (GDT; 255 [Guidant Corp., St. Paul, MN, USA]), St. Jude Medical (SJM; 73 [St. Paul, MN, USA]), and Biotronik (BTK; 15 [Biotronik GmBH, Berlin, Germany]). After eliminating devices explanted for elective replacement indicator (ERI, 541), 51.9% of pacemakers (41/79), 54.2% of implantable cardioverter-defibrillators (ICDs) (64/118), and 47.6% of cardiac resynchronization therapy and defibrillation (CRT-D) devices (30/63) had sufficient battery life and no evidence of electrical malfunction to be considered for reuse. A logistic regression analysis found that the indications for device removal independently predicted reusability: upgrade to an ICD (odds ratio [OR] 162.8, P < 0.001) or CRT-D (OR 63.8, P < 0.001), infection (OR 110.7, P < 0.001), heart transplantation or left ventricular assist device placement (OR 56.6, P < 0.001), and device removal at patient's request (OR 115.4, P < 0.001).
The majority of explanted CIEDs for reasons other than ERI have an adequate battery life and, if proven safe, may conceivably be reutilized for basic pacing in underserved nations where access to this life-saving therapy is limited.
先前的研究表明，起搏器再利用可能是在低收入和中等收入国家提供设备治疗的一种合理选择。我们在一家三级医疗中心研究了心脏植入式电子设备（CIED）的植入指征和剩余电池寿命。
我们对2007年至2011年间在密歇根大学取出的所有CIED进行了回顾性研究。如果电池寿命≥48个月或剩余电池寿命>75%；没有电气故障的证据，且未处于咨询或召回状态，则这些设备被视为可再利用。共取出801个CIED：美敦力（MDT[美敦力公司，明尼阿波利斯，明尼苏达州，美国]；454个）、波士顿科学（BS[波士顿科学公司，纳蒂克，马萨诸塞州，美国]）/Guidant（GDT；255个[Guidant公司，圣保罗，明尼苏达州，美国]）、圣犹达医疗（SJM；73个[圣保罗，明尼苏达州，美国]）和百多力（BTK；15个[百多力有限公司，柏林，德国]）。在排除因择期更换指征（ERI）而取出的设备（541个）后，51.9%的起搏器（41/79）、54.2%的植入式心律转复除颤器（ICD）（64/118）和47.6%的心脏再同步治疗除颤器（CRT-D）设备（30/63）具有足够的电池寿命且没有电气故障的证据，可考虑再利用。逻辑回归分析发现，设备移除的指征可独立预测再利用性：升级为ICD（比值比[OR]162.8，P<0.001）或CRT-D（OR 63.8，P<0.001）、感染（OR 110.7，P<0.001）、心脏移植或左心室辅助装置置入（OR 56.6，P<0.001）以及应患者要求移除设备（OR 115.4，P<0.001）。
因ERI以外的原因取出的大多数CIED具有足够的电池寿命，并且如果经证明安全，在获得这种救命治疗有限的服务不足国家，可想象它们可被重新用于基本起搏。
