Cardiovascular Journal of Africa: Vol 26 No 4 (July/August 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015 186 AFRICA
more infections were found in the new pacemaker group (7%)
than in the re-used pacemaker group (2%). Kantharia et al.25
found no significant complications in an Indian study cohort
of 53 patients who received cadaveric donated resterilised
pacemakers over a mean follow up of 661 days.
Panja et al.26 found no difference in infection rates between the
new pacemaker group and cadaver-donated re-used pacemakers.
However, higher rates of infection were found on infected
re-sterilised devices that were implanted in the same patient,
which were taken out and implanted on the opposite side.
They attributed this higher infection rate to haematogenous
or lymphatic spread from the previously infected pocket.26
Rosengarten et al.27 also found no significant difference in major
pacemaker-related complications and reported that re-use of
devices is cost effective.
Pavri et al.,24 in a retrospective, single-centre cohort study of
re-sterilised ICDs found no device-related infections, and 60.4%
re-used ICDs delivered life-saving shocks. Baman et al.,28 in a
meta-analysis of 18 studies, found no significant difference in
infection rates between the new device group and the re-used
device group, but much higher device malfunction was associated
with re-used devices compared to new devices. This malfunction
was attributed to abnormality in the set screws.28
In a recent study, Nava et al.23 found no significant difference
in infection rates between re-used and new devices, although
more infections were found in the new device group. They also
found more device malfunction in the re-use device group, which
was similar to the above studies, and the fault was also attributed
to faulty pacemaker screws.23
Device infection is thought to be associated with mortality
rates between 2.6 and 18%.12-14 However studies that examined
this issue showed no significant difference in infection or
mortality rates between re-used and new device implantation.14-22
In our study we did not compare mortality rates between the
two groups because of the selection bias of those who received
a re-used pacemaker.
From the findings of this study and also acknowledging its
limitations, pacemaker and ICD re-use is feasible and safe. It is
a reasonable option for those who cannot afford new devices,
provided that proper selection and sterilisation measures of
re-used devices are followed. In the developing world, where
there are major resource constraints, this option should be
explored for the benefit of those suffering from symptomatic
bradyarrhythmias and life-threatening tachyarrhythmias.
We acknowledge several limitations of our study. First, this
was a retrospective study with a small sample size of cases with
re-used pacemakers and ICDs. Second, the follow-up period of
patients with re-used devices was relatively short, with a median
period of 15 months, with a significant number of patients who
died within three months of device insertion. Finally, the patients
who were selected for re-used pacemakers had significant
co-morbidities, which were associated with a shortened life-span.
These factors may limit the generalisability of the study, and call
for appropriate prospective studies to answer this question.
Conclusion
Pacemaker and ICD re-use is feasible and safe in the short term
(i.e. over months) provided that the devices for re-use are selected
carefully and proper sterilisation methods are followed. Re-used
pacemakers and ICDs are a realistic option for patients with
co-morbidities who live in developing countries where there is
limited access to pacemakers and ICDs.
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