Landolina Maurizio, Curnis Antonio, Morani Giovanni, Vado Antonello, Ammendola Ernesto, D'onofrio Antonio, Stabile Giuseppe, Crosato Martino, Petracci Barbara, Ceriotti Carlo, Bontempi Luca, Morosato Martina, Ballari Gian Paolo, Gasparini Maurizio
Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy Dipartimento di Cardiologia, A.O. Ospedale Maggiore di Crema, Largo Ugo Dossena 2, Crema (Cremona) 26013, Italy
Ospedali Civili, Brescia, Italy.
Europace. 2015 Aug;17(8):1251-8. doi: 10.1093/europace/euv109. Epub 2015 May 14.
Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices.
We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57-2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25-2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45-0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47-0.89; P = 0.008) were additional factors associated with replacement for battery depletion.
The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers.
植入式心脏复律除颤器（ICD）在电池耗尽时进行设备更换可能会带来相当大的并发症风险，并给医疗系统带来成本。因此，从临床和经济角度来看，ICD设备的使用寿命极其重要。心脏再同步治疗除颤器（CRT-D）的电池寿命比ICD短。我们确定了因电池耗尽而进行更换的比例，并在一系列接受CRT-D设备植入的患者中确定了早期耗尽的可能决定因素。
我们检索了2008年1月至2010年3月在9个中心连续植入的1726个CRT-D系统的数据。在成功进行CRT-D植入手术后5年，46%的设备因电池耗尽而被更换。目前不同制造商的CRT-D系统因电池耗尽而进行设备更换的时间差异很大，5年后仍在使用的电池比例在52%至88%之间（对数秩检验，P<0.001）。左心室导联输出和单极起搏配置是早期耗尽的独立决定因素[风险比（HR）：1.96；95%置信区间（CI）：1.57 - 2.46；P<0.001和HR：1.58，95%CI：1.25 - 2.01；P<0.001，分别]。植入新一代设备（HR：0.57；95%CI：0.45 - 0.72；P<0.001）、电池化学性质和CRT-D制造商（HR：0.64；95%CI：0.47 - 0.89；P = 0.008）是与因电池耗尽而更换相关的其他因素。
5年时设备的使用寿命为54%。高左心室导联输出和单极起搏配置与早期电池耗尽有关，而新一代CRT-D的使用寿命更长。目前不同制造商的CRT-D系统之间出现了显著差异。
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