Christopher R. Ellis , Tiffanie Markus , Deanna Dickerman , Jodi M

AMPERE HOUR AS A PREDICTOR OF CRT ICD PULSE GENERATOR BATTERY LONGEVITY
A Multi-Center Study
Christopher R.
1Vanderbilt
1
Ellis ,
Tiffanie
1
Markus ,
Deanna
1
Dickerman ,
Jodi M.
1
Orton ,
Sohail
University Medical Center, 2Eastside Cardiovascular, 3University of Michigan Health System, 4Thomas Jefferson University
INTRODUCTION
CRT-D devices offer survival benefit in select NYHA class II-IV systolic heart failure patients with QRS >120ms and LVEF <35%. A limitation of 100% CRT
pacing is excess battery drain, and earlier pulse generator (PG) replacement for CRT systems. CRT-D pulse generator change is associated with
significant infection risk, morbidity, and cost. Ampere-hour or Ah measures residual PG battery capacity and may predict device longevity.
METHODS
We performed a multi-center retrospective study of all CRT-D devices implanted at our centers from August 1, 2008 to December 31, 2010. PG survival
was calculated from implant date to time of PG replacement, heart transplant, device infection, or patient death. Analysis was performed between 1.0 Ah,
1.4 Ah, and 2.0 Ah devices as defined by manufacturers specifications. Comparison was made between devices for the presence of atrial fibrillation (AF),
high LV lead output (>3V @ 1ms), >3 ICD shocks in the lifetime of the device, and % atrial pacing by quartile.
RESULTS
Data were collected from 710 patients at 4 sites with data collection through December 2013. Data collection through September 2014 were available on
997 CRT-D devices from 7 sites for presentation of this study. Patients were followed over an average of 3.1 ± 1.3 years (582 1Ah (Medtronic), 266 2Ah
(Boston Scientific) and 149 1.4Ah (St. Jude Medical)). Average age at implant was 67.1 ± 11.8 yrs., mean LVEF was 25.3 ± 12.8%, mean QRS duration
152.4 ± 25.0 ms, and 71.0% were NYHA class III. Chronic LV output >3V @ 1 ms, and >3 ICD shocks per device lifetime were distributed equally.
• Patients with 1Ah CRT-D had lower AF burden (32.9% vs. 46.1% (2 Ah), and 53.4% (1.4 Ah), p =0.0006). 1 Ah devices were more likely to have >75%
atrial pacing (20.4%, vs 8.6% (2 Ah), 16.7% (1.4 Ah), p= 0.005).
• CRT-D replacement (ERI) occurred in 12.4% of 1 Ah systems (72/582), versus 4.0% in 1.4 Ah, (6/149), and 0.4% in 2 Ah devices (1/266) over mean
follow up of 3.1 yrs
CONCLUSIONS
Ampere hour (Ah) is a useful predictor of survival to ERI for modern CRT-D generators. Further study is warranted to determine the cost and morbidity
associated with earlier CRT-D pulse generator change in 1 Ah systems.
REFERENCES
Bristow, MR, et al. "Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure." New England Journal of Medicine 350.21 (2004): 2140-2150.
Alam, MB, et al. "Battery longevity in cardiac resynchronization therapy implantable cardioverter defibrillators." Europace 16.2 (2014): 246-251.
Horlbeck, FW, et al. "Real‐World Data on the Lifespan of Implantable Cardioverter‐Defibrillators Depending on Manufacturers and the Amount of Ventricular Pacing." Journal of cardiovascular electrophysiology 23.12 (2012): 1336-1342.
Kramer, DB, et al. "Mortality risk following replacement implantable cardioverter-defibrillator implantation at end of battery life: Results from the NCDR®." Heart Rhythm 11.2 (2014): 216-221.
Schaer, BA, et al. "Longevity of implantable cardioverter-defibrillators, influencing factors, and comparison to industry-projected longevity." Heart Rhythm 6.12 (2009): 1737-1743.
Thijssen, J, et al. "Implantable cardioverter-defibrillator longevity under clinical circumstances: an analysis according to device type, generation, and manufacturer." Heart Rhythm 9.4 (2012): 513-519.
AUTHOR DISCLOSURE INFORMATION
C.R. Ellis: Grant/Research Support; Company Relationship; Thoratec Inc., Heart Ware Inc., Boston Scientific, Boehringer-Ingelheim. Honoraria; Company Relationship; Biotronik Inc.. Consultant; Company Relationship; TyRx Inc..
E.D. Good: Grant/Research Support; Company Relationship; Medtronic Inc., Boston Scientific. Consultant; Company Relationship; Biotronik Inc.
A. Greenspon: Grant/Research Support; Company Relationship; Boston Scientific, Medtronic Inc..
T. Markus: None. D. Dickerman: None. J.M. Orton: None. S. Hassan: None. T. Okabe: None.
Additional Study Sites
Robert Wood Johnson University Hospital (Ashok Patel MD, Subhashini Gowda MD, Dwayne Siu MD); Cooper University Health Care (John Andriulli DO, FACC); North Ohio Heart (Kara Quan MD)
2
Hassan ,
Eric D.
3
Good ,
Toshimasa
4
Okabe , Arnold
4
Greenspon

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