https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 2Kardiologen am Brückenkopf Fachärzte für Innere Medizin & Kardiologie Heidelberg, Deutschland
Introduction
Cardiac pacing has significantly improved patient outcomes since its inception in 1958. Pacing and resynchronization are now vital in managing cardiac rhythm and treating end-stage heart failure. This case report highlights a patient implanted with a dual-chamber pacemaker in September 1989, whose battery remains at the Beginning of Life (BOL) status over three decades later.
Case Report
A patient presented with syncopal episodes during a hiking tour in the Alps. Due to the lack of detailed medical records, information, apart from pacemaker memory, is based on medical history. A basic cardiac assessment, including coronary angiography and echocardiography, led to the transvenous implantation of a dual-chamber pacemaker due to suspected higher degree heart block. The system includes unipolar right atrial (RA) and unipolar right ventricular (RV) leads, connected to a Guidant DELTA/VISTA generator. Over the years, the patient underwent routine follow-ups in various outpatient practices. In January 2024, Boston Scientific updated the Latitude Programming System hardware, prompting the patient to visit our department for device control. The pacing system, older than the attending physician, functioned perfectly under VVI 50 programming with a battery voltage of 2.77 volts, still at BOL. The patient exhibited sinus rhythm at 76 bpm.
Discussion
The longevity of this pacemaker system is truly remarkable, showcasing the resilience and durability of early cardiac pacing technology. The lithium-ion battery has maintained a BOL status for over three decades, highlighting the impressive engineering and reliability of devices from this era. This case exemplifies the term 'old but gold,' as it continues to perform optimally well beyond its anticipated lifespan. The exceptional lifespan of this device can be attributed to several factors, including the initial design, the quality of the components, and the efficiency in minimizing energy consumption and needs for pacing. Modern pacing techniques, such as His-Purkinje and left bundle branch pacing, often face challenges related to high energy consumption due to elevated pacing thresholds. While leadless pacing represents a significant advancement in the field, its long-term durability compared to traditional systems remains uncertain. However, their long-term performance and battery life must be rigorously evaluated to determine if they can match the durability of traditional pacemakers. This underscores the ongoing need for innovation in battery technology to ensure that newer devices can achieve similar longevity.
Conclusion
The case of a patient with a pacemaker functioning over three decades exemplifies the durability of cardiac pacing technology. Continuous innovation and refinement in CIED technologies promise to extend this legacy, enhancing patient care and shaping the future of cardiac rhythm management.