Reuse of Explanted, Resterilized Implantable Cardioverter-Defibrillators: A Cohort Study

Oct 25, 2012
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Authors:
Pavri B, Lokhandwala Y, Kulkarni GV, Shah M, Kantharia BK, Mascarenhas DA.
Citation:
Ann Intern Med 2012;157:542-548.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Is the reuse of implantable cardioverter-defibrillators (ICDs) feasible?

Methods:

This was a retrospective analysis of 81 patients (mean age 52.6 years) in Mumbai, India, with a class I indication for an ICD that was otherwise unaffordable, who received an ICD explanted in the United States. The explanted ICDs all had a battery voltage of ≥3.0 V or projected longevity of ≥3 years, and underwent thorough cleaning and ethylene oxide gas sterilization.

Results:

A total of 106 explanted ICDs (26 biventricular, 80 single- or dual-chamber) were implanted in the 81 patients. The mean time to explantation was 17 months, and the mean interval between explantation and implantation was 12.5 months. The mean battery voltage was 3.1 V. During a mean follow-up of 27.5 months, 22 patients underwent a second ICD implant, and three required a third implant because of battery depletion. There were no device infections. Appropriate shocks or antitachycardia pacing occurred in 54% of patients. Nine patients died during follow-up, with no deaths attributable to ICD malfunction.

Conclusions:

Explanted ICDs can be safely reused in patients who cannot afford the device.

Perspective:

The ICD implant rate in countries with large numbers of lower economic class individuals is a fraction of the implant rate in developed countries, largely because of cost issues. This study demonstrates that ICDs that are explanted because of upgrades, infections, or death can be safely reused and can provide life-saving therapies to individuals who otherwise would be at high risk of sudden death. The results of the study make a strong case for expansion of this type of humanitarian effort.

Keywords: Receptors, Bradykinin, Ethylene Oxide, Shock, Longevity, Prostheses and Implants, Tachycardia, Ventricular, Developed Countries, India, Pacemaker, Artificial, United States, Bradykinin, Defibrillators, Implantable, Death, Sudden, Cardiac


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