Variability in implantable cardioverter-defibrillator battery longevity

Background: Implantable cardioverter-defibrillator (ICD) battery longevity impacts the need for generator replacement, with the accompanying risk of complications and cost. Objective: We sought to identify factors associated with ICD battery longevity and compare manufacturers. Methods: We used a nationwide, multicenter remote monitoring dataset (PaceMate) to evaluate ICDs implanted between 2003 and 2023, assessing time from implant to replacement interval (RI). We compared Kaplan-Meier survival curves and device parameters across manufacturers. We evaluated observed vs manufacturer-estimated battery longevity in devices that reached RI and compared estimated longevity for devices implanted in the last 2 years vs older. We performed Cox regression to measure battery longevity by device type, adjusting for manufacturer and parameters. Results: We evaluated 15,029 single-chamber, 10,822 dual-chamber, and 17,247 biventricular ICDs. Each additional lead resulted in approximately 2–3 years of lost battery longevity. Among devices reaching RI, Boston Scientific (BSX) transvenous had the longest longevity for single-chamber, dual-chamber, and biventricular ICDs by 2–3 years. Device parameters did not substantially vary across manufacturers. Among devices reaching RI, estimated and observed longevity were similar for all manufacturers. Estimated longevity improved by 2–4 years with ICDs implanted in the last 2 years, with attenuated differences between manufacturers. Manufacturer, programmed pulse width, and programmed output were the strongest determinants of longevity. Conclusion: ICD battery longevity varied substantially across device type (2–3 years less per additional lead) and by manufacturer (2–3 year differences). Newer devices had markedly improved longevity (2–4 years). Factors most associated with longevity were manufacturer, programmed pulse width, and programmed output.