The reuse of cardiac pacemakers

To provide decision makers with a synthesis of the relevant information concerning the safety of pacemaker reuse, the ethical and legal issues which it raises and the extent of financial savings which may result.

Medline data bank and the bibliographies of review articles in English concerning refurbishment and reuse of cardiac pacemakers published up to June 1991.

Since 1978, reports of safe reuse of pacemakers have appeared in 11 countries. By 1984, review of nearly 2000 installations had produced no evidence of increased mortality or morbidity. The norms which must be respected to ensure safety are now well-known. The savings that might result from reuse can only be approximated. In Canada in 1989, 8684 pacemakers were installed. Assuming that 20% might be available for reuse, this practice might save approximately $4,000,000 per year to the Canadian health care system.

Properly carried out, pacemakers can be reused at an acceptably low risk. Any institution contemplating pacemaker reuse should define and approve appropriate guidelines and protocols governing the process. A registry to document the reuse of pacemakers for the next few years is desirable.