REPROGRAMMING PACEMAKERS ENHANCES LONGEVITY AND IS COST-EFFECTIVE

Background Historically, the majority of pulse generators implanted in the United States remain at the nominal programmed settings from the time of implant. While these nominal settings typically allow a suffic ient safety margin to prevent later loss of capture with potential chr onic threshold rise, the pulse generator with significant use would no t be expected to last longer than that predicted by the manufacturer. However, improvements in lead technology have resulted in significantl y lower chronic capture thresholds, which would permit lower programma ble output settings while still allowing acceptable safety margins. Su ch changes could result in a significant reduction in long-term batter y drain and translate into longer generator life. Methods and Results One hundred eighty consecutive patients undergoing implantation of per manent pacemakers at our institution were studied to determine the imp act of reprogramming on pulse generator longevity and cost. Of these p atients, 122 completed 6 months of follow-up at our institution and ha d pulse generators implanted that were capable of measuring battery cu rrent. We compared the estimated longevity based on battery current at nominal settings with that based on settings achieved in follow-up. T he final settings were determined by the patient's physician using sta ndard safety margins. The predicted longevity was 6.95+/-1.59 years at nominal implant settings and 11.16+/-2.71 years at final programmed s ettings (P<.001). Therefore, reprogramming extends the estimated pulse generator longevity by 4.25+/-2.14 years (64%) at a mean cost of $110 per patient ($37 per year extended). Conclusions Reprogramming of per manent pacemakers is efficacious and cost-effective.