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Short battery life of pacemakers puts patients at risk of serious complications

Over half of patients will need new batteries and several replacements

Caroline White

Friday, 05 February 2016

Over half of patients with pacemakers will need new batteries, and many devices will need replacing several times as a result, which exposes patients to serious complications, including life threatening infection, warn senior doctors in an editorial* in The BMJ.

The battery life of these implantable devices must be improved, they argue, adding that replacements are expensive.

The situation is worse for patients with an implantable cardioverter defibrillator (ICD), say cardiologists John Dean and Neil Sulke of the Royal Devon and Exeter and Eastbourne hospitals.

This is because the risks of infection at the time of implant and device replacement are higher than with pacemakers, added to which the batteries have a shorter life of around four to seven years, on average.

“The increased risk of infection associated with battery replacement makes it critical that we prolong the life of implantable devices as much as possible,” they write.

But the current financial model discourages the development of longer life devices, they insist. “With financial disincentives for both manufacturers and purchasers it is hardly surprising that longer life devices do not exist,” they say.

Furthermore, patients are often assumed to prefer smaller devices, they say, but when offered the choice, over 90% would opt for a larger, longer lasting device over a smaller one that requires more frequent operations to change the battery.

“We need to review the timing of replacement of implantable devices in all patients,” they write. “While early replacement may be reasonable for high-risk patients, allowing batteries to deplete for longer before replacement in lower risk patients could help to maximise device longevity,” they say.

The waste is even more striking for ICDs, they add. These devices reach their elective replacement indication when they are still capable of delivering at least six full energy shocks. “So for patients who receive no shock therapy we are prematurely discarding a device costing up to £25,000, which could last at least another six months.”

They suggest that with existing technology, engineers could design and build pacemakers that would last for 25 years or more, while further developments in battery technology might enable smaller or rechargeable devices.

“There is an urgent need to minimise the requirement for replacement of these devices. Doing so will save lives, minimise suffering, and reduce costs,” they conclude.

* Dean J, Neil Sulke N. Pacemaker battery scandal. BMJ 2016;352:i228. doi: 10.1136/bmj.i228

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