The reality of implantable cardioverter-defibrillator longevity: what can be done to improve cost-effectiveness?

r a o v s p Multiple clinical trials have demonstrated the mortality benefit of implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death, expanding the indications for device therapy. However, ICDs are expensive and patient longevity often exceeds pulse generator longevity, so many patients will require replacement of pulse generators, which is associated with additional costs. Generator replacement also carries a substantial risk for complications even when performed electively. While the overall risk of initial implantation complicaions is 3.2% in the National Cardiovascular Data Registry ICD egistry, the risk of major complications for generator replaceents is 4.1%–5.8%, with complications including death. Risks are even higher for patients undergoing system upgrade, and risks of pocket-related adverse events requiring surgical intervention increase with every consecutive replacement. Therefore, it is eneficial to reduce the need for upgrade or replacement of pulse enerators. In the current issue of HeartRhythm, Thijssen et al assess the ongevity of 4673 ICDs implanted since 1996, identifying that 2% were replaced because of battery depletion. Overall, the ean device longevity was only 5.0 0.1 years and slightly onger at 5.5 0.1 years for devices replaced because of battery depletion.