Patients implanted today with an ICD or CRT-D are younger and younger. This is due to progressively widened ICD indications as well as a preference for performing implants in patients with better life expectancy.
The same is also true for CRT patients. Ever since CRT recommendations were extended to include mildly symptomatic patients, patients have started to be implanted at an earlier stage in their disease which is why today we see that patients are living with their devices for much longer periods of time than before.
of implants take place in patients less than 70 years old.1
of patients need at least one replacement for battery depletion.2
ICD and CRT-D patients exhibit long term survival benefits following device implant. Therefore, almost one third of the patients undergo device replacement due to battery depletion.
occurrences of surgical reinterventions
for infections or other causes.3
increase ICD lead issues.4
Device replacement is a short procedure but with serious outcomes. The risk of complications is twice as high at reintervention than at first implant.3
Lead malfunction is an important cause of morbidity and mortality in patients with an ICD and the failure of high-voltage leads significantly increases after ICD generator replacement. In fact, replacement leads to a five-fold increase of ICD lead issues. Avoiding device replacement limits the risk of ICD lead failure.4
Swedish ICD and Pacemaker Registry – Annual statistic report 2014. https://www. pacemakerregistret.se/icdpmr/start.do.
Ramachandra I. Impact of ICD battery Longevity on Need for Device Replacements Insight from Veterans Affairs Database. PACE 2010; 33:314-319.
Borleffs CJW, Thijssen J, Mihaly K et al. Recurrent Implantable Cardioverter Defibrillator Replacement Is Associated with Increasing Risk of Pocket-Related Complications. Pacing Clinical electrophysiology 2013;33:1013-19. 10.
Lovelock JD, Cruz C, Hoskins MH et al. Generator replacement is associated with an increased rate of ICD alerts. Heart Rhythm 2014;11(10):1785-89.