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Pacemaker battery scandal - Maximising battery longevity in cardiac implantable electronic devices

Paula Atienza discusses the recent Pacemaker battery scandal  

Posted on 16 February 2016

A recent article in the British Medical Journal (BMJ)  has raised concerns over battery longevity in cardiac implantable electronic devices. It appears to suggest a link between the profits of manufacturers, implanting physicians and their institutions to the lack of longer lasting batteries in life-saving devices.

Cardiac implantable electronic devices are implanted into patients in order to monitor the heart’s rhythm. There are different types of devices depending on patient needs. A pacemaker is a small device that is placed inside someone’s chest in order to help the heart beat at the correct speed. Another device is an implantable cardioverter defibrillator (ICD), which delivers electrical shocks to restore a normal heart rhythm when necessary.

Battery Replacement
A battery powered pulse generator in these devices produces the electrical discharges necessary to monitor the heart’s rhythm. Studies have shown that over half the patients with pacemakers will require a replacement procedure due to the batteries having reached their expected life, with some patients necessitating multiple replacements. ICDs batteries tend to have a shorter life than those found in pacemakers.

As with any procedure, complications can occur and with each battery replacement there is an increased risk of life threatening infection. The article advocates for a prudent use of currently available devices along with development in battery longevity technology.

Delaying Battery Replacement
Increasingly, cardiac implantable electronic devices are being closely controlled through home monitoring devices which, the authors suggest, could be used as a tool to appropriately delay battery replacement. The article submits that pacemakers continue to be replaced while the battery has not yet depleted. This early replacement is understandable when it comes to high risk patients who depend on their device for lifesaving treatment. However, the authors suggest that a delay in battery replacement in lower risk patients, basically until the batteries are close to being depleted, could be appropriate.
The need to delay battery replacement becomes even more apparent in ICDs, where devices costing up to £25,000, which could last a further six years, are being prematurely replaced.

The authors provide some suggestions for delaying battery replacement surgery as much as possible.

Increasing Device Size
  • A study by the cardiology division at the Department of Medicine at the Albert Einstein College of Medicine in New York concluded that “the vast majority of patients prefer a larger device to reduce the number of potential replacement operations”. Patients must be offered a choice as to whether they would prefer a smaller device or a larger device with a longer lasting battery.  
Smart Programming
  • Closely monitoring patients through smart programming in order to decide whether it could be more beneficial to allow the battery to deplete further before replacement, and in some cases possibly concluding that device replacement might not be the best option.
Investing in Rechargeable Technology and Energy Harvesting
  • Investment into longer lasting batteries alongside aiming to make devices smaller appears key in reducing the need for battery replacement surgery.
What appears crucial is that patients must be allowed to voice their opinion in a debate which, for the time being, appears to be governed by the financial incentives of manufacturers, physicians and medical institutions, which might not always have the patients best interest at heart.