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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015
AFRICA
181
Performance of re-used pacemakers and implantable
cardioverter defibrillators compared with new devices at
Groote Schuur Hospital in Cape Town, South Africa
Zimasa V Jama, Ashley Chin, Motasim Badri, Bongani M Mayosi
Abstract
Objectives:
Little is known about the performance of re-used
pacemakers and implantable cardioverter defibrillators
(ICDs) in Africa. We sought to compare the risk of infection
and the rate of malfunction of re-used pacemakers and ICDs
with new devices implanted at Groote Schuur Hospital in
Cape Town, South Africa.
Methods:
This was a retrospective case comparison study of
the performance of re-used pacemakers and ICDs in compar-
ison with new devices implanted at Groote Schuur Hospital
over a 10-year period. The outcomes were incidence of device
infection, device malfunction, early battery depletion, and
device removal due to infection, malfunction, or early battery
depletion.
Results:
Data for 126 devices implanted in 126 patients
between 2003 and 2013 were analysed, of which 102 (81%)
were pacemakers (51 re-used and 51 new) and 24 (19%) were
ICDs (12 re-used and 12 new). There was no device infec-
tion, malfunction, early battery depletion or device removal
in either the re-used or new pacemaker groups over the
median follow up of 15.1 months [interquartile range (IQR),
1.3–36.24 months] for the re-used pacemakers, and 55.8
months (IQR, 20.3–77.8 months) for the new pacemakers. In
the ICD group, no device infection occurred over a median
follow up of 35.9 months (IQR, 17.0–70.9 months) for the
re-used ICDs and 45.7 months (IQR, 37.6–53.7 months) for
the new ICDs. One device delivered inappropriate shocks,
which resolved without intervention and with no harm to
the patient. This re-used ICD subsequently needed genera-
tor replacement 14 months later. In both the pacemaker and
ICD groups, there were no procedure-non-related infections
documented for the respective follow-up periods.
Conclusion:
No significant differences were found in perfor-
mance between re-used and new pacemakers and ICDs with
regard to infection rates, device malfunction, battery life and
device removal for complications. Pacemaker and ICD re-use
is feasible and safe and is a viable option for patients with
bradyarrhythmias and tachyarrthythmias.
Keywords:
re-used devices, pacemakers, ICDs, performance,
safety
Submitted 17/2/15, accepted 12/4/15
Cardiovasc J Afr
2015;
26
: 181–187
www.cvja.co.zaDOI: 10.5830/CVJA-2015-048
Pacemaker implantation is an effective tool to treat
bradyarrhythmias, and implantable cardioverter defibrillators
(ICD) reduce mortality in patients at high risk of sudden
death.
1
The challenge with pacemakers and ICDs is the high
cost of these devices. The pacemaker generator, in its most basic
form, costs US$2 500–3 000 and leads cost US$800–1 000.
2
An
ICD generator costs US$20 000–40 000 and leads cost over
US$10 000.
2
The high cost of pacemakers and ICDs has resulted
in limited access of deserving patients in poor countries to these
life-saving interventions.
3-5
Mond
et al
.
6
demonstrated an increase in pacemaker and
ICD implantation rates in all countries that participated in the
World Survey of Cardiac Pacing in 2009. Despite this increase in
implantation rates, there was a huge difference in the number of
implants between the developed and underprivileged countries,
with more implants in the developed world.
6
This disparity was
explained mainly by the high cost of these devices.
6
Re-use of cardiac pacemakers has been practiced since the
early 1970s.
7
The major concern with this practice is the risk of
device infection and malfunction.
8-11
Device infection is the most
feared complication of cardiac device re-use and is thought to
be associated with case fatality rates between 2.6 and 18%.
12-14
However, some studies from America, Europe and Asia that
examined the performance of re-used pacemakers and ICDs
have shown no significant difference in infection or mortality
rates between patients who received re-used and new devices.
14-22
The aim of this study was to investigate the performance of
re-used pacemakers and ICDs at Groote Schuur Hospital, Cape
Town, South Africa.
Methods
This was a retrospective case comparison study of performance
of re-used versus new pacemakers and ICDs at Groote Schuur
Hospital, Cape Town, South Africa. We included consecutive
devices that were implanted between 1 January 2003 and 1
January 2013. As shown in Fig. 1, there were 1 721 devices
implanted during that time, of which 1 587 (92.2%) were
pacemakers and 134 (7.8%) were ICDs. Of the 1 587 pacemakers,
1 257 (79.2%) were new implants and 330 (20.8%) were generator
replacements. Of the 134 ICDs, 114 (85.1%) were new implants
and 20 (14.9%) were generator replacements.
There were 54 (3.4%) re-used pacemakers and 12 (9%) re-used
ICDs implanted during this period, with a total number of 66
The Cardiac Clinic, Department of Medicine, Groote
Schuur Hospital, Cape Town, South Africa
Zimasa V Jama, MB ChB,
zvjama@gmail.comAshley Chin, FCP (SA), MPhil
Bongani M Mayosi, FCP (SA), DPhil
College of Medicine, King Saudi Bin, Abdulaziz University
for Medical Sciences, Riyadh, Kingdom of Saudi Arabia
Motasim Badri, PhD