Espicom View : With cardiovascular rhythm management sales declining for the big medical device companies, anything that will give them a boost over competitors is an advantage. Medtronic and Boston Scientific have been swiping at each other over battery longevity for a while now, and drawing attention to this study is Boston Scientific's latest move to claim that its devices are better than Medtronic's, albeit with a study comparing devices from three years ago. While this war of words rages between Medtronic and Boston Scientific, Biotronik, a company not mentioned in this study, may be able to come and lay claim to some of the implantable cardiac device market.
Boston Scientific is touting a study, Battery Longevity in Cardiac Resynchronization Therapy Implantable Cardioverter Defibrillators, from the University of Pittsburgh Medical Center, published online on October 6 in EP EuroPace (10.1093/europace/eut301), which showed that there are significant differences in battery longevity between contemporary cardiac resynchronisation therapy defibrillator (CRT-D) devices. The study found that the Boston Scientific device has the longest battery life compared with competitive brands. It was noted that battery life can have direct implications on patient outcomes and may therefore impact clinical practice in CRT-D therapy. This study was sponsored exclusively by University of Pittsburgh Medical Center.
This retrospective, observational study focused on a cohort of 646 patients who were implanted with current models of CRT-D defibrillators between January 1 2008 and December 31 2010. The primary endpoints were the rate of battery depletion (reaching elective replacement indicator), as well as the time from device implantation to battery depletion as specified by device manufacturer. Overall, study data demonstrated the shortest battery longevity in contemporary Medtronic CRT-D models compared with comparable devices from other manufacturers. During 2.7+/-1.5 years of follow-up, 4% of Boston Scientific device batteries had depleted, compared with 7% from St Jude Medical (SJM) and 25% from Medtronic (p<0.001). Moreover, the four-year battery survival rate of the Boston Scientific device was 94%, compared with 92% from SJM and 67% from Medtronic (p<0.001).
CRT implantable cardioverter defibrillators (ICDs) are indicated for the management of heart failure patients with severe left ventricular (LV) systolic dysfunction and a wide QRS complex. The benefit of CRT-ICDs depends upon achieving a high burden of ventricular pacing in both the right and LV, with greater benefit seen at or near 100% biventricular pacing. The need for nearly 100% biventricular pacing can cause a significant battery drain and is usually the major determinant of battery longevity.
Joe Fitzgerald, president, Cardiac Rhythm Management, Boston Scientific, stated that the performance reviews of the company's CRT-Ds have validated the company's industry-leading five-year survival probability. The company offers CRT-Ds and ICDs designed to be the world's longest lasting, with nearly double the battery capacity of some other available models.
Boston Scientific, SJM and Medtronic have all been facing declining sales in the cardiovascular rhythm management market. Medtronic had recently received FDA clearance for its Viva range of CRT-D devices, claiming an 11 year battery longevity, with many reporting that Boston Scientific released an advert stating that Medtronic's device only lasted 4.6 years in clinical testing, whiles its own device lasts 7.7 years. Medtronic then labelled Boston Scientific's claims as misleading. SJM has yet to weigh in on the device longevity argument. Biotronik, not mentioned in the University of Pittsburgh study, has recently launched its CRT-D with a claimed longevity of 11.5 years. If this is proved in a real-world setting, the small company, which is trailblazing new technologies in implantable cardiovascular devices, may be able to take market share from these three giants.