Pacemaker ICD Battery

Longest Lasting CRT-D Pacemaker?

Who has the longest lasting CRT-D Pacemaker Battery?


longest lasting CRT-D

LivaNova (formerly Sorin) have launched their Platinum ICD and CRT-D range of cardiac devices. LivaNova claim to have the longest lasting CRT-D. This got me wondering Who has the longest lasting CRT-D Pacemaker Battery?

Traditionally battery longevity calculations have been made using different criteria as manufacturers market their devices in the best light possible. Are LivaNova comparing apples with other apples? This article curates the battery longevity claims of the newest CRT-D devices with CRT optimisation algorithms where applicable. Every longevity prediction is based on slightly different criteria but here are the claims from the manufacturers for their latest devices.

Who has the longest lasting CRT-D Pacemaker?

Battery Longevity of the LivaNova Platinum CRT-D with SonR Active

Claimed Longevity: 10 Years

Longevity Calculations Based On:

  • DDD mode, 60bpm with no rate response
  • Automatic CRT optimisation on
  • 30% atrial pacing
  • 100% pacing in both ventricles
  • All lead impedances at 600 Ohms
  • A and RV output pulses of 2.5V at 0.35ms
  • LV output pulse of 3.0V at 0.35ms
  • 3 maximum charge shocks per year
  • Sensor Off
  • Remote check daily, 4 follow-ups and 5 full alert reports per year
  • 150 minute implant and peri-implant interrogation
  • 60 minutes of clinic follow ups each year

Battery: Great Batch Quaser High Rate – lithium/ silver vanadium oxide and carbon mono-flouride

Warranty: 6 Years (with SonR CRT optimisation algorithm)

N.B. The Platinum family of devices do not accommodate a quadripolar lead where as many of the other devices listed do have an IS4 version. Click here for the advantages of a quadripolar lead.

Battery Longevity of the Biotronik Itrevia 7 CRT-D

Claimed Longevity: 6.9 Years

Longevity Calculations Based On:

  • DDD mode, sensing atrial rate at 70bpm with no rate response
  • Automatic CRT optimisation: None available
  • 0% atrial pacing
  • 100% pacing in both ventricles
  • All lead impedances at 700 Ohms
  • A and RV output pulses of 2.5V at 0.4ms
  • LV output pulse of 3V at 0.4ms
  • 4 maximum shocks per year
  • Sensor Off
  • One Home Monitoring® message per day and four remote follow-ups per year with eight event messages per year
  • Implant and peri-implant allowance not stated.
  • Up to 19 months use by date (UBD)

Battery: Great Batch 2992 – lithium/ silver vanadium oxide and carbon mono-flouride

Warranty: 5 Years

Battery Longevity of the Medtronic Viva XT CRT-D

Claimed Longevity: 7.1 years

Longevity Calculations Based On:

  • DDD mode, 60 bpm
  • Automatic CRT optimisation off
  • Optivol Fluid Status Monitoring On
  • 15% atrial pacing
  • 100% pacing in both ventricles
  • All lead impedances at 600 Ohms
  • A, RV and LV output pulses of 2.5V at 0.4ms
  • Capture Management on
  • 2 Maximum charge shocks per year
  • Remote checks and interrogation allowance for longevity predictions not stated.

Battery: Hybrid CFx lithium/silver vanadium oxide

Warranty: 6 Years (4 + 2 years)

Battery Longevity of the Boston Scientific Autogen CRT-D

Claimed Longevity: 8.9 Years

Longevity Calculations Based On:

  • DDDR mode, 70 bpm
  • Automatic CRT optimisation off
  • 0% atrial pacing
  • 100% pacing in both ventricles
  • RA impedance 500 Ohms, 700 Ohms RV and LV
  • A and RV output pulses of 2.0V at 0.4ms
  • LV output pulse of 3.0V at 0.4ms
  • 3 maximum charge shocks per year
  • Sensor On
  • Remote check daily, monthly interrogations, scheduled remote follow ups, and quarterly patient interrogations
  • 180 minutes implant and peri-implant interrogation
  • 40 minutes of clinic follow ups each year
  • 12 months storage.

Battery: Enduralife Lithium/Manganese Dioxide

Warranty: 6 Years

Battery Longevity of the St Jude Unify Assura CRT-D

Claimed Longevity: 6.6 Years

Longevity Calculations Based On:

  • DDD mode, 60 bpm
  • Automatic CRT optimisation off
  • 100% atrial pacing
  • 100% pacing in both ventricles
  • All lead impedances at 500 Ohms
  • A, RV and LV output pulses of 2.5V at 0.5ms
  • 3 Maximum charge shocks per year
  • Remote checks and interrogation allowance for longevity predictions not stated.

So Who has the longest lasting CRT-D Pacemaker?

If you are not experienced in interpreting this data then please do not try to do so. The battery longevity is very dependent on how the device is set up. For example I appreciate that on face value St Jude battery looks to have the shortest longevity prediction compared to its competitors. However they do allow for 100% atrial pacing, longer output pulse widths and  lower lead impedances than many (all of which will drain battery faster). These factors are out of the control of the manufacturer and therefore cannot be guaranteed – in essence battery longevity has many different variables making it very difficult to predict. Another important factor is that the technology and energy demands of the other electrical components that comprise a pacemaker are vital in battery longevity predictions. For instance, due to the type of capacitor technology used by Medtronic, their devices do not require quarterly or even semi-annual capacitor formation to retain their short charge time performance. As each full energy charge uses almost a month of battery life, this is a significant saving and must be factored in when making longevity predictions.

Previous studies into the longest lasting CRT-D Pacemaker

We can also look at previous device battery longevities to help answer the question and there are several studies over the last few years into proven battery longevity. Just remember these studies compare the previous device generations and none of the devices detailed on this page.

The studies do seemingly indicate that a Lithium/Manganese Dioxide is a favourable battery chemistry and that the Amp-Hour Rating of a battery does seem to reliably influence the device longevity (the greater the Amp Hour Rating the longer the CRT-D seems to last). They also clearly show that device circuitry, software and active algorithms have a huge influence on the longevity of the device.

Summary to who has the longest lasting CRT-D Pacemaker?

I know I have sat on the fence and this is deliberate…

In this post I wanted to achieve two things, firstly to present the data in one place as it is a pain in the arse trying to get some of this information. Secondly to highlight that battery longevity predictions should be more standardised (although different algorithms make this very challenging), this would make data much easier to interpret and true longevity more transparent.

Remember “having the best battery also does not make a CRT-D the best on the market – it needs to be accompanied with other factors – fewest inappropriate shocks, lowest complication or recall risk and greatest improvement quality of life.”

Kristian Webb

If you work for any of these companies and notice any inaccuracies then please let me know and I will amend the article immediately.

I am sure this article is going to draw comments but please keep it civil – unlike a thread I read on cafepharma once!

Comments 10

  1. Excellent, comprehensive article! The cited studies overwhelmingly indicate that battery chemistry and amp hours are clear indicators of longevity. Utilizing a device longevity calculator, I entered the parameters you described in the Medtronic projection. The Boston Scientific device would last 7 years. Basing your calculations on amp hours, the Medtronic device would actually only last 3.0 years, the Biotronik device 4.9 years, and the St. Jude device 5.8 years. The real question is, what is the impact? With an 8% infection rate associated with device implant and generator changes, it is clear that a longer-lasting device truly matters! Add to that healthcare costs to the patient and hospitals and suddenly longevity truly matters!

    1. Profile photo of Kristian Webb Post
      Author

      Hi Tracy,
      Thanks for your reply it is always worth reaffirming the infection rate associated with these procedures. I am always cautious about battery longevity predictions as they are just that. I have little to no expertise in to battery chemistry and the effects on drain and predictability so I deliberately do not comment on the ‘best’ battery. What I believe to be true is that when deconstructing the hardware of a device, Amp hour rating is just one piece of the jigsaw in device longevity (albeit an important one). So whilst the longevity of the 2 hour Amp Hour battery compared favorably in the last generation of devices – the information takes a step towards irrelevance when comparing the newer devices, where not only changes in circuitry (for instance Sorin) but also the algorithms running in the CPU have changed. Therefore I would be in no way comfortable drawing upon this data to forecast the longevity of the newest generation – especially from one manufacturer to another when the components and software has a competitive covertness to it. I am not ignoring the facts but being impartially cautious. We know that the larger a batteries Amp Hour Rating – the longer it would last given an identical burden to that of a battery with a lesser Amp-hour rating. In the last generation of devices we can now say that the Amp Hour rating seemed to hold true in spite of discrepancies in other longevity determinants. In the next generation of devices the other longevity determinants have changed so we categorically cannot use this data with any confidence to predict longevity until we have much more data at our disposal. Of course I would not be surprised if it turns out that the 2 Amp Hour battery compared favorably but I would also not be surprised if it didn’t. I think an analogy explains my point better: Take three cars with different size fuel tanks and study them to see how many miles the car will travel on a full tank of fuel. It turns out that the car with the largest petrol tank did manage the most miles… now take these three fuel tanks and put them in 3 different cars and tell me which one will travel the furthest?
      Even though fuel tank size is a positive indicator of how many miles the car will achieve, we cannot reliably predict the answer when you do not know all of the fixed variables (weight of vehicle, wheel profile, number of gears) and those that are not predetermined (the speed, the driver, the terrain and the weather). Boston have their variables to hand but do they truly know all of the technology and software variables of their competitors newest devices?
      I hope this explains my cautious approach and why even though battery prediction does contribute to device selection for my patients – there are other considerations that are of equal importance.

    1. Profile photo of Kristian Webb Post
      Author

      Hi Steve,
      A CRT-D is a pacemaker at its core, with additional functionality built in. You could of course argue that it is not a brady-pacemaker but even then it still has brady-pacing functionality.
      Kristian

  2. Very interesting article. It come out with two questions
    1°) I wonder if it would be more accurate to compare a Platinum CRTD (without SonR), as SonR is an additional sensor
    2°) How does it related with other models such as VR/DR?
    Anyway thanks a lot for the time spend to recap everything.

  3. Profile photo of Kristian Webb Post
    Author
  4. Fantastic commentary and a tip of the hat to you for the time & effort devoted to constructing this informational piece. A quick question for you concerning Sorin’s new family of CRT devices. You note the Platinium CRT will not be compatible with quadripolar leads however a company spokesperson informed us differently. Can you confirm that “yes” or “no”, the device will or will not be compatible with quadripolar leads?Thank you in advance.

  5. Hi Kristian,

    Well done for bringing this to light. I have also examined this and every thing you have summarized to date is correct.

    Longevity can be estimated very well from:
    1) Battery size (total, but more importantly, usable)
    2) Housekeeping current
    3) Cap reforms per year
    4) Pacing rate, % pace, impedance of pace, voltage of the pace (raised to the square)
    5) Shelf-life

    Indeed when you look at the variety of predictions made in each company’s manual, you can fit them all to a graph using pacing rate, % pace and voltage squared (assuming standard impedance, shocks, housekeeping, battery size and shelf-life).

    The usable battery for Boston Autogen and LivaNova Platinium are identical (1.9 Ah); in comparison Medtronic Viva XT is 1.0 Ah.

    I don’t have the data to hand for defibs but I know that LivaNova has a 6.5 microAmp drain for housekeeping in their brady device in comparison to Medtronic and Boston at ~ 10 microAmps for their brady devices.

    I know that these efficiencies have been brought over to the Platinium family and hence, it is not surprising that the Platinium is a CLEAR winner in longevity when comparing apples with apples; because it has the equal largest battery on the market and one of the lowest housekeeping currents. Furthermore, (free plug for the RESPOND CRT trial results!) the SonR sensor has just been shown to be the ONLY CRT device to further improve outcomes beyond that of CRT itself with a 35% reduction in HF hospitalizations in a gold standard double-blind RCT study design in > 1000 patients.

    Less probability for box change + an auto-optimisation algorithm that improves REAL clinical outcomes = a good device in my mind.

    Good work Kristian; there are too many “smoke and mirrors” battery estimates out there (for instance Medtronic manual quotes longevities assuming the pre-EGM storage is only switched on for 6 months! – switching them on all of the time further reduces their estimates by 16%)

    Boston used to be the market leader in high voltage longevity, now its LivaNova’s turn – with earlier implants, longer lives and the economic and health implications for box changes, it has never been more important to select a device with longevity in mind.

    Kind Regards

    Anthony

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