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Friday, April 23, 2021

Another battery related recall for Medtronic implantable electronic devices


Has Medtronic had more battery related problems than other pacemaker manufacturers or does it just seem that way because of the number of recalls and battery life estimation issues reported in the last 2 -3 years and the fact that Medtronic makes more units than any other company? Medtronic is not alone. both Guidant and St. Jude have had major recalls .

Premature battery failure lead to St Jude's recall of ICDs and CRT-D units involving over 300 thousand world wide with 250000 in the US.Reports indicate that St. Jude knew of the problem for years before the recall. One death was reported in 2014 and a second death in 2016 before the October 2016 recall was issued.St Jude was purchased by Abbott.

A similar narrative can be told about Guidant who became aware of a shorting issue in their Prize II IC which did not allow the unit to deliver a shock while also destroying the  shocking system . Guidant informed the FDA and fixed the problem but did not warn physicians nor patients and continued to sell some units that had not been modified.The Prize was introduced into the market in 2000,  the flaw discovered in 2003 but it was not until  2005 that the company disclosed the problem. Finally in  October 2013 Boston Scientific who had purchased  Guidant pleaded guilty to a false claims act litigation and agreed to pay 296 million dollar fine. 

There were problems with  Medtronic CIED programmers in units made between October 2018 and January 2019 that resulted in erroneous estimate of battery life.These were ultimately corrected and in the end seemed to be really more of an anxiety producing nuisance than a threat. 

Also in 2019 there were three reports of pacemaker batteries being completely drained resulting in one death.This problems involved five different Medtronic models and 131000 units and involved a potential capacitor damage. This situation was troublesome to both EP cardiologists and the patients as there was no way to determine which specific units were likely to fail and pacemaker replacement is not a risk free minor procedure. Having a complicated device under your chest wall skin is anxiety producing enough without the added worry that the type unit you have had been known to suddenly fail. It seems to be a recurrent situation with CIED recalls that there is no way to determine if a particular unit within a class of units subject to the recall is in fact one that is doomed to fail.

On 2/3/2021 Medtronic send an "Urgent Medical Device Correction" letter to all affected physicians.  On 4/12/2021 The FDA announced a recall of about 240,00 Medtronic CIEDS.These are seven models of  CRT-ICDs and pacemaker ICDs. see here for link  This is a class I recall which means a potential risk for serious  injury or  death.

When a Medtronic pacemaker reaches a certain predetermined battery life remaining signal  the device is said to go to a RRT  setting or condition (Recommended replacement time) which sets a 3 month clock ticking before it goes to the next condition which is called ERT (elective replacement time).This condition, which I understand is unique to Medtronic PMs involves a Mode switch  to a VVI mode at a heart rate of 65.

Some devices involved in this latest recall may move from the RRT warning to full battery depletion in as little as 24 hours.There have been over 400 complaints with these devices and 18 "injuries" also reported. Generally PMS do not have a system feature that notifies patient or physician when RRT is reached. I will not know if my PM has reached RRT until a remote  ( or office ) interrogation designates that.(I have a five year old Medtronic model "Consulta"

 Questions come to mind-

Has Medtronic contacted the approximate quarter million patients who have these units or does the letter send to the physicians put the onus on the docs to spread the word?

Does the typical PM clinic have computerized records of which PM each of their patients have? 

A 2017 report from office of the inspector general estimated that 1.5 billion dollars had been paid by Medicare for replacement of 7 different models of CIED in 73,000 patients during the time period 2005-2013.According to the report manufacturers do not typically pay for replacement costs, 

Medtronic has also had recalls recently for its HVAD units (see here) and its blood pump (see here)

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