2022 Quality Summit ePosters (Non-CE) - Electrophysiology Accreditation-1. Modeling Long-term Effect of Subcutaneous versus Transvenous Defibrillator Battery Capacity on Major Complications and Costs Associated with Replacement Procedures

1. Modeling Long-term Effect of Subcutaneous versus Transvenous Defibrillator Battery Capacity on Major Complications and Costs Associated with Replacement Procedures

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A model was developed to compare the cost and complication rates of different types of implantable cardioverter defibrillators (ICDs). The model compared the 0.8Ah subcutaneous (SC) ICD with single chamber transvenous (TV) ICD generators of varying battery capacities (1.0Ah, 1.9Ah, and 2.0Ah). The results showed that the 2.0Ah TV ICD had fewer generator replacements and lower costs compared to the SC ICD and the smaller battery capacity TV ICDs. However, the SC ICD had the fewest long-term complications.<br /><br />The study found that the total number of implant procedures for patients would be reduced with the 2.0Ah TV ICD, resulting in cost savings for payers and society. On the other hand, the SC ICD had fewer complications in the long term. The decision on which type of device to implant should be made through a complex informed consent discussion between the physician and the patient, considering factors such as costs, the number of replacement procedures, and overall long-term complication rates.<br /><br />The limitations of the study included not accounting for variation in the reliability of different TV leads and not considering the value of the TV ICD pacing functions. Additionally, the estimates of major complications may be lower than the actual complication rates.<br /><br />In conclusion, the 2.0Ah TV ICD was associated with fewer replacement procedures and costs compared to smaller battery capacity TV ICDs and the SC ICD. However, the SC ICD had the fewest long-term complications. The choice of implant type should be based on a careful consideration of these factors and a discussion with the patient.

Keywords

implantable cardioverter defibrillators

cost

complication rates

0.8Ah subcutaneous ICD

single chamber transvenous ICD

battery capacities

generator replacements

long-term complications

implant procedures

informed consent discussion