Advertisement
Heart, Lung and Circulation

Cardiac Implantable Electronic Devices: Reoperations and the Competing Risk of Death

  • Marianne H. Gillam
    Correspondence
    Corresponding author at: The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
    Affiliations
    School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
    Search for articles by this author
  • Nicole L. Pratt
    Affiliations
    School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
    Search for articles by this author
  • Author Footnotes
    1 Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
    Maria C.S. Inacio
    Footnotes
    1 Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
    Affiliations
    School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
    Search for articles by this author
  • Sepehr Shakib
    Affiliations
    Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Department of Medicine, University of Adelaide, Adelaide, SA, Australia

    Australia and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
    Search for articles by this author
  • Author Footnotes
    1 Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
    Gillian E. Caughey
    Footnotes
    1 Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
    Affiliations
    School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
    Search for articles by this author
  • Prashanthan Sanders
    Affiliations
    Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
    Search for articles by this author
  • Dennis H. Lau
    Affiliations
    Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
    Search for articles by this author
  • Elizabeth E. Roughead
    Affiliations
    School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
    Search for articles by this author
  • Author Footnotes
    1 Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
Published:October 18, 2021DOI:https://doi.org/10.1016/j.hlc.2021.08.027

      Background

      The use of cardiac implantable electronic devices (CIED), which includes pacemakers, implantable cardioverter-defibrillators (ICD), cardiac resynchronisation therapy pacemakers (CRT-P) and cardiac resynchronisation therapy defibrillators (CRT-D) has increased over the past 20 years, but there is a lack of real world evidence on the longevity of these devices in the older population which is essential to inform health care delivery and support clinical decisions.

      Methods and Results

      We conducted a retrospective cohort study using data from the Australian Government Department of Veterans’ Affairs database. The cohort consisted of people who had a CIED procedure between 2005 and 2015. The cumulative risk of generator replacement/reoperations was estimated accounting for the competing risk of death. A total of 16,662 patients were included. In pacemaker recipients with an average age of 85 years, the 5-year risk of reoperation ranged from 2.8% in single chamber, 3.6% in dual chamber to 7.6% in CRT-P recipients, while the 5-year risk of dying with the index pacemaker in situ was 63% in single chamber, 46% in dual chamber and 56% in CRT-P recipients. In defibrillator recipients with an average age of 80 years, the 5-year risk of reoperation ranged from 11% in single chamber, 13% in dual chamber to 24% in CRT-D recipients, while the 5-year risk of dying with the index defibrillator in situ was 46% in single chamber, 40% in dual chamber and 41% in CRT-D recipients.

      Conclusion

      In this cohort of older patients the 5-year risk of generator reoperation was low in pacemaker recipients whereas up to one in four CRT-D recipients would have a reoperation within 5 years.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mond H.G.
        • Proclemer A.
        The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia's project.
        Pacing Clin Electrophysiol. 2011; 34: 1013-1027
        • Valzania C.
        • Torbica A.
        • Tarricone R.
        • Leyva F.
        • Boriani G.
        Implant rates of cardiac implantable electrical devices in Europe: a systematic literature review.
        Health Policy. 2016; 120: 1-15
        • Mond H.G.
        • Crozier I.
        The Australian and New Zealand cardiac pacemaker and implantable cardioverter-defibrillator survey: calendar year 2013.
        Heart Lung Circ. 2015; 24: 291-297
        • Pathik B.
        • Mathew T.
        • Chahadi F.
        • Sutton K.
        • McGavigan A.D.
        Cardiac resynchronisation therapy in patients with atrioventricular nodal disease and reduced ejection fraction - can we afford it?.
        Heart Lung Circ. 2015; 24: 354-358
        • Brignole M.
        • Auricchio A.
        • Baron-Esquivias G.
        • Bordachar P.
        • European Society of Cardiology, European Heart Rhythm Association
        • et al.
        2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).
        Europace. 2013; 15: 1070-1118
        • Tung P.
        • Albert C.M.
        Causes and prevention of sudden cardiac death in the elderly.
        Nat Rev Cardiol. 2013; 10: 135-142
        • Pellegrini C.N.
        • Lee K.
        • Olgin J.E.
        • Turakhia M.P.
        • Tseng Z.H.
        • Lee R.
        • et al.
        Impact of advanced age on survival in patients with implantable cardioverter defibrillators.
        Europace. 2008; 10: 1296-1301
        • Mezu U.
        • Adelstein E.
        • Jain S.
        • Saba S.
        Effectiveness of implantable defibrillators in octogenarians and nonagenarians for primary prevention of sudden cardiac death.
        Am J Cardiol. 2011; 108: 718-722
        • Yung D.
        • Birnie D.
        • Dorian P.
        • Healey J.S.
        • Simpson C.S.
        • Crystal E.
        • et al.
        Survival after implantable cardioverter-defibrillator implantation in the elderly.
        Circulation. 2013; 127: 2383-2392
        • Lee D.S.
        • Tu J.V.
        • Austin P.C.
        • Dorian P.
        • Yee R.
        • Chong A.
        • et al.
        Effect of cardiac and noncardiac conditions on survival after defibrillator implantation.
        J Am Coll Cardiol. 2007; 49: 2408-2415
        • Healey J.S.
        • Hallstrom A.P.
        • Kuck K.H.
        • Nair G.
        • Schron E.P.
        • Roberts R.S.
        • et al.
        Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias.
        Eur Heart J. 2007; 28: 1746-1749
        • Fauchier L.
        • Alonso C.
        • Anselme F.
        • Blangy H.
        • Bordachar P.
        • Boveda S.
        • et al.
        Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Societe Francaise de Cardiologie and Societe Francaise de Geriatrie et Gerontologie.
        Arch Cardiovasc Dis. 2016; 109: 563-585
        • Epstein A.E.
        • Kay G.N.
        • Plumb V.J.
        • McElderry H.T.
        • Doppalapudi H.
        • Yamada T.
        • et al.
        Implantable cardioverter-defibrillator prescription in the elderly.
        Heart Rhythm. 2009; 6: 1136-1143
        • Saba S.
        • Adelstein E.
        • Wold N.
        • Stein K.
        • Jones P.
        Influence of patients' age at implantation on mortality and defibrillator shocks.
        Europace. 2017; 19: 802-807
        • Brignole M.
        • Auricchio A.
        • Baron-Esquivias G.
        • Bordachar P.
        • Boriani G.
        • Breithardt O.A.
        • et al.
        2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).
        Eur Heart J. 2013; 34: 2281-2329
        • Australian Government Department of Veterans' Affairs
        DVA Data for Research.
        • The Prostheses List
        Australian Government Department of Health.
        • Vitry A.
        • Wong S.A.
        • Roughead E.E.
        • Ramsay E.
        • Barratt J.
        Validity of medication-based co-morbidity indices in the Australian elderly population.
        Aust N Z J Public Health. 2009; 33: 126-130
        • Austin P.C.
        • Lee D.S.
        • Fine J.P.
        Introduction to the analysis of survival data in the presence of competing risks.
        Circulation. 2016; 133: 601-609
        • Lamas G.A.
        • Orav E.J.
        • Stambler B.S.
        • Ellenbogen K.A.
        • Sgarbossa E.B.
        • Huang S.K.
        • et al.
        Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators.
        N Engl J Med. 1998; 338: 1097-1104
        • Wilson D.G.
        • Zeljko H.M.
        • Leventopoulos G.
        • Nauman A.
        • Sylvester G.E.
        • Yue A.
        • et al.
        Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks analysis.
        Europace. 2017; 19: 275-281
        • Ranasinghe I.
        • Parzynski C.S.
        • Freeman J.V.
        • Dreyer R.P.
        • Ross J.S.
        • Akar J.G.
        • et al.
        Long-term risk for device-related complications and reoperations after implantable cardioverter-defibrillator implantation: an observational cohort study.
        Ann Intern Med. 2016; 165: 20-29
        • Sears S.F.
        • Rosman L.
        • Sasaki S.
        • Kondo Y.
        • Sterns L.D.
        • Schloss E.J.
        • et al.
        Defibrillator shocks and their effect on objective and subjective patient outcomes: results of the PainFree SST clinical trial.
        Heart Rhythm. 2018; 15: 734-740
        • Perini A.P.
        • Kutyifa V.
        • Veazie P.
        • Daubert J.P.
        • Schuger C.
        • Zareba W.
        • et al.
        Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: a MADIT-RIT substudy.
        Am Heart J. 2017; 189: 75-84
        • Goonewardene M.
        • Barra S.
        • Heck P.
        • Begley D.
        • Fynn S.
        • Virdee M.
        • et al.
        Cardioverter-defibrillator implantation and generator replacement in the octogenarian.
        Europace. 2015; 17: 409-416
        • Suleiman M.
        • Goldenberg I.
        • Haim M.
        • Schliamser J.E.
        • Boulos M.
        • Ilan M.
        • et al.
        Clinical characteristics and outcomes of elderly patients treated with an implantable cardioverter-defibrillator or cardiac resynchronization therapy in a real-world setting: data from the Israeli ICD Registry.
        Heart Rhythm. 2014; 11: 435-441
        • Weber D.
        • Koller M.
        • Theuns D.
        • Yap S.
        • Kuhne M.
        • Sticherling C.
        • et al.
        Predicting defibrillator benefit in patients with cardiac resynchronization therapy: a competing risk study.
        Heart Rhythm. 2019; 16: 1057-1064
        • Bradshaw P.J.
        • Stobie P.
        • Knuiman M.W.
        • Briffa T.G.
        • Hobbs M.S.
        Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population.
        Open Heart. 2014; 1: e000177
        • Bradshaw P.J.
        • Stobie P.
        • Briffa T.
        • Hobbs M.S.
        Use and long-term outcomes of implantable cardioverter-defibrillators, 1990 to 2009.
        Am Heart J. 2013; 165: 816-822
        • Burch A.W.
        • Wong C.X.
        • Sullivan T.
        • Brooks A.G.
        • Leong D.P.
        • Lau D.H.
        • et al.
        Trends in the use of implantable cardioverter defibrillators in Australia: a 10-year nationwide study from 2000-2009.
        Intern Med J. 2013; 43: 888-895
        • de Vries L.M.
        • Leening M.J.G.
        • Dijk W.A.
        • Hooijschuur C.A.M.
        • Stricker B.H.C.
        • van Hemel N.M.
        Trends in service time of pacemakers in the Netherlands: a long-term nationwide follow-up study.
        Neth Heart J. 2017; 25: 581-591
        • Zanon F.
        • Martignani C.
        • Ammendola E.
        • Menardi E.
        • Narducci M.L.
        • Filippo P.D.E.
        • et al.
        Device longevity in a contemporary cohort of ICD/CRT-D patients undergoing device replacement.
        J Cardiovasc Electrophysiol. 2016; 27: 840-845
        • Munawar D.A.
        • Mahajan R.
        • Linz D.
        • Wong G.R.
        • Khokhar K.B.
        • Thiyagarajah A.
        • et al.
        Predicted longevity of contemporary cardiac implantable electronic devices: a call for industry-wide “standardized” reporting.
        Heart Rhythm. 2018; 15: 1756-1763
        • Gadler F.
        • Valzania C.
        • Linde C.
        Current use of implantable electrical devices in Sweden: data from the Swedish pacemaker and implantable cardioverter-defibrillator registry.
        Europace. 2015; 17: 69-77
        • Landolina M.
        • Curnis A.
        • Morani G.
        • Vado A.
        • Ammendola E.
        • D'Onofrio A.
        • et al.
        Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer.
        Europace. 2015; 17: 1251-1258
        • Kramer D.B.
        • Kennedy K.F.
        • Noseworthy P.A.
        • Buxton A.E.
        • Josephson M.E.
        • Normand S.L.
        • et al.
        Characteristics and outcomes of patients receiving new and replacement implantable cardioverter-defibrillators: results from the NCDR.
        Circ Cardiovasc Qual Outcomes. 2013; 6: 488-497
        • Manolis A.S.
        • Maounis T.
        • Koulouris S.
        • Vassilikos V.
        “Real life” longevity of implantable cardioverter-defibrillator devices.
        Clin Cardiol. 2017; 40: 759-764
        • von Gunten S.
        • Schaer B.A.
        • Yap S.C.
        • Szili-Torok T.
        • Kuhne M.
        • Sticherling C.
        • et al.
        Longevity of implantable cardioverter defibrillators: a comparison among manufacturers and over time.
        Europace. 2016; 18: 710-717