<p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">The </span><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fwww.bmj.com%2fcontent%2f352%2fbmj.i228" target="_blank"><span class="Hyperlink__Char">short battery life</span></a><span class="Normal_0020_0028Web_0029__Char"> of cardiac devices, such as pacemakers and implantable cardioverter defibrillators (ICDs), is a “scandal,” two cardiologists argued.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">A depleted device leads to replacement procedures and the increased odds of infection that go along with them, so it is “critical that we prolong the life of implantable devices as much as possible,” John Dean, MD, of Royal Devon and Exeter Hospital, and </span><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fwww.cvshealthcare.co.uk%2fstaff%2fneil-sulke.php" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">Neil Sulke, MD</span></span></a><span class="Normal_0020_0028Web_0029__Char">, of Eastbourne Hospital, both in the U.K., wrote online in </span><span class="Emphasis__Char"><span class="Emphasis__Char">BMJ</span></span><span class="Normal_0020_0028Web_0029__Char">.</span></p> <p class="Normal_0020_0028Web_0029"><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fwww.emoryhealthcare.org%2fphysicians%2fm%2fmerchant-faisal.html" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">Faisal M. Merchant, MD</span></span></a><span class="Normal_0020_0028Web_0029__Char">, of Emory Healthcare in Atlanta, agreed, telling </span><span class="Emphasis__Char"><span class="Emphasis__Char">MedPage Today </span></span><span class="Normal_0020_0028Web_0029__Char">in a telephone interview that “the more times you change the battery, the more the patient is exposed to risks such as infection. And the risk is cumulative, so every time you do it, the risk goes up a little more.”</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">He added that the problem with pacemakers and ICDs today is that “the battery technology is not there the way it is for other devices, like cell phones.”</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Device manufacturers may have had a hand in that, according to Dean and Sulke. “The current financial model discourages the development of longer life devices. Increasing longevity would reduce profits for manufacturers, implanting physicians, and their institutions,” they explained, suggesting why “it is hardly surprising that longer life devices do not exist.”</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">However, “I don’t know that the financial incentives are so misaligned that it’s a scandal,” Merchant countered. “It implies that there’s some sort of collusion on the part of the device companies. There may be some truth to that, but if a manufacturer came out with a device with a longer battery life that would actually give them a market advantage.”</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">In any case, the bottom line is that “there is an urgent need to minimize the requirement for replacement of these devices. Doing so will save lives, minimize suffering, and reduce costs,” Dean and Sulke wrote.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">To that end, the pair suggested that clinicians “delay replacement of the pulse generator until the batteries are virtually depleted in lower risk patients,” given that “devices are usually replaced when there is still substantial life left in the battery.”</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">“When a pacemaker reaches elective replacement indication, it is usually 3-12 months before it will reach the end of life. And even then, the battery may continue to function for several months,” they reasoned, acknowledging, however, that patients who are “entirely dependent” on their devices are a different story.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">“Pacer-dependent patients or those requiring cardiac resynchronization therapy may need earlier replacement, as would patients with frequent ventricular arrhythmias,” agreed </span><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fclinicaldepartments.musc.edu%2fmedicine%2fdivisions%2fcardiology%2ffaculty%2fgold.htm" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">Michael R. Gold, MD, PhD</span></span></a><span class="Normal_0020_0028Web_0029__Char">, of Medical University of South Carolina in Charleston, in an email to </span><span class="Emphasis__Char"><span class="Emphasis__Char">MedPage Today</span></span><span class="Normal_0020_0028Web_0029__Char">.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">“There’s something to be gained by not being so aggressive in changing the device,” Merchant said.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Dean and Sulke also suggested that patients would prefer a longer battery life — even if it came in a larger device — though Merchant was not sold on the idea. “The larger the device, the higher the risk of infection when you have to do something to it later. It’s hard to know where the sweet spot lies with respect to size,” he said.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Better yet is to remember that “there are ways to program the device so its outputs are not so necessarily high. Those programming strategies are important — focusing on them is really key and is what we can do for now,” Merchant emphasized.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Additionally, operators can “put pressure on the device industry to move towards adopting new technologies” that will maximize battery life, according to </span><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2ffindadoc.upmc.com%2fPhysicianBioQuery.aspx%3fEPCDID%3d1771" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">Samir F. Saba, MD</span></span></a><span class="Normal_0020_0028Web_0029__Char">, of the University of Pittsburgh Medical Center.</span></p> <p class="Normal_0020_0028Web_0029"><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fwww.musgroveparkhospital.nhs.uk%2fwards-and-departments%2fconsultants%2fmark-dayer%2f" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">Mark J. Dayer, PhD</span></span></a><span class="Normal_0020_0028Web_0029__Char"> of England’s Musgrove Park Hospital, noted in an </span><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fwww.bmj.com%2fcontent%2f352%2fbmj.i228%2frr-0" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">online editorial</span></span></a><span class="Normal_0020_0028Web_0029__Char"> that although “the differences [between devices] are there to see in the manufacturers’ product performance reports,” they are rarely read by cardiologists due to “the dense nature of the texts.”</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">That’s why “choosing the device that has a better longevity track record” is another step that clinicians can take today, Saba told</span><span class="Emphasis__Char"><span class="Emphasis__Char">MedPage Today</span></span><span class="Normal_0020_0028Web_0029__Char">, and another opportunity to improve patient outcomes.</span></p> <p class="Normal"><a name="_GoBack"></a><span class="Normal__Char">Disclosures</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Dean, Sulke, and Merchant reported no relevant conflicts of interest.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Saba reported receiving research support from Medtronic, Boston Scientific, and St. Jude Medical.</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Dayer disclosed relationships with Medtronic, Boston Scientific, St. Jude Medical, Biotronik, and Sorin (LivaNova).</span></p> <p class="Normal_0020_0028Web_0029"><span class="Normal_0020_0028Web_0029__Char">Gold reported consulting for Boston Scientific, Medtronic, and St. Jude Medical.</span></p> <p class="Normal"><span class="Normal__Char">Sources</span></p> <p class="Normal"><span class="Normal__Char">The BMJ</span></p> <p class="Normal"><a href="https://owa.medstar.net/owa/redir.aspx?C=hLpkxlYCKEqz4bSiISaA2lTEx1IWONNIZQ8wvCBnBR-UIrE_20jXje8x_3TFpnzHmo9JNB5pEuU.&URL=http%3a%2f%2fwww.bmj.com%2fcontent%2f352%2fbmj.i228" target="_blank"><span class="Hyperlink__Char"><span class="Hyperlink__Char">http://www.bmj.com/content/352/bmj.i228</span></span></a></p> <p class="Normal"><span class="Normal__Char">Dean J and Sulke N et al “Pacemaker battery scandal” </span><span class="Emphasis__Char"><span class="Emphasis__Char">BMJ</span></span><span class="Normal__Char"> 2016; DOI: 10.1136/bmj.i228</span></p>