A prospective trial of new versus refurbished cardiac pacemakers: a Canadian experience

Pacemaker reimplantation in the same patient is common, and pacemaker transplantation or reuse in a second patient has been reported. No report prospectively compares the long term costs, the impact of reuse on the number of pacemakers implanted, the pacemaker related complications, the types of patients selected and the patient survival of those who receive new versus a refurbished pacemaker. The authors implanted 70 pacemakers of which 75% (52) were new and 25% (18) were refurbished. The refurbished pacemakers were implanted in older patients (P less than 0.02), with a mean +/- SD of 77 +/- 8 versus 69 +/- 13 years of age. During a follow-up period of 36 months, the rate of pacemaker related complications was the same in both groups, with no unusual or unexpected problems arising in the refurbished group. There were 12 (23%) complications in the new pacemaker group and four (22%) complications in the refurbished pacemaker group. There were no major pacemaker related complications, no pacemaker battery depletions and no pacemaker related deaths. The refurbished pacemakers saved $33,000. After three years the cumulative probability of survival in the new group tended to be higher (P = 0.08) with a mean (SE) of 0.62 (0.12) versus 0.44 (0.15). New and refurbished pacemakers are similar with respect to pacemaker related survival and complications. Refurbished pacemakers effect a major reduction in pacemaker costs while maintaining health care standards.