Interventional cardiology

What’s trending in implantable devices?

After being ‘early adopters’ of cardiac pacemakers and cardioverter-defibrillators, use of the devices by cardiologists in Australia and New Zealand is flattening, latest figures show.

And use of replacement implants is still high but is dropping, according to a comparison of sales data between 2013 and 2017. The trend, due largely to improved power source service life, means pacemaker replacements now comprise about 16% of the pacemaker hardware budget for Australia and 18% for New Zealand.

The sales data, supplied by cardiac implantable electronic device companies, provides a snapshot of the activity occurring in 141 Australian and 10 New Zealand centres.

Overall, there was a modest rise in the total number of pacemaker sales from 18,867 to 21,433 (up 12%) in Australia and from 2,135 to 2,196 (up 3%) in New Zealand between 2013 and 2017.

However the survey found the implantable cardio-defibrillator (ICD) market was relatively flat.

“For 2017, there were 4,212 new ICDs implanted in Australia (3,904 in 2013) and 396 ICDs in New Zealand (423 in 2013).”

ICD replacements remain a significant proportion of all implants at about one third of the ICD hardware market.

“The improvement in projected power source service life can also be extended to ICDs, but the reduction in replacement numbers will still take a number of years,” the authors wrote in Heart, Lung and Circulation.

The survey also confirmed the trend towards biventricular pacemakers for cardiac resynchronisation therapy with an increase in use of 47% compared to 2013 in Australia and 28% in New Zealand.

The authors said most biventricular pacemaker recipients would qualify for an ICD, but for reasons including patient or physician preference, cost, prognosis or technical difficulties, a pacemaker was preferred.

The survey also found 15,175 atrial and 17,716 ventricular leads were implanted in Australia during 2017 and 1,809 atrial and 2,231 ventricular leads in New Zealand.

“In both countries there has been an overwhelming shift to active fixation steroid-eluting leads in both chambers.”

The authors also noted that Australia had one of the highest rates of new implants per million population – second behind Germany for ICDs and comparable to Belgium, Denmark and France behind Germany for pacemakers.

Associate Professor Mond, from Monash University and Cato Cardiology, told the limbic the findings represented natural progression in the context of Australia’s early adoption of cardiac implantable electronic devices, the introduction of new technologies, and high standards of care.

“We were limited [in the survey] to the general pacemakers and cardioverter defibrillators that are sold in Australia but it did show trends in the lead technology for instance.”

He said the survey could unfortunately not include technologies such as leadless pacemakers, subcutaneous defibrillators and implantable loop recorders, where the few companies involved were reluctant to share usage information.

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