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Published on: February 28, 2012
Nationwide Lifespan Trends in Cardiac Implantable Electronic Device Strategies in Japan: Age-Dependent Changes in
Aya Miyazaki1,2,3,4, Gaku Izumi1,2,5, Shuhei Fujita1,2,6,7
1CIEDs Working Group of Japanese Society of Pediatric Electrocardiology Japan.
Background:
Nationwide epidemiological studies of cardiac implantable electronic devices (CIEDs) encompassing multiple device types and strategies remain limited in Japan, particularly regarding epicardial lead use and pediatric populations.
Methods:
We performed the first nationwide analysis of CIED implantation trends using the National Database of Health Insurance Claims, including transvenous (TV)/epicardial (Epi) systems for pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and CRT-defibrillators (CRTDs), as well as leadless pacemakers, subcutaneous ICDs (S-ICDs), and epicardial lead use. Epicardial lead and pediatric characteristics were supplemented using industry data.
Results:
In fiscal year 2023, implantation rates per 100 000 population were 29.69 for TV-pacemakers, 7.06 for leadless pacemakers, 2.42 for TV-ICDs, 0.889 for S-ICDs, 1.20 for TV-CRT, and 1.69 for TV-CRTDs. Rates for epicardial systems were lower, at 0.173 for Epi-pacemakers, 0-0.007 for Epi-ICDs, 0.024 for Epi-CRT, and 0.027 for Epi-CRTDs, while epicardial lead use was 0.545. S-ICD use increased across age groups, whereas TV-ICD implantation declined (all p < 0.001). Implantation of TV and leadless pacemakers, TV-CRT, and TV-CRTDs increased over time (all p < 0.001). Epicardial lead use showed a bimodal age distribution, peaking in pediatric and elderly populations, and declined in older adults while remaining stable in children and adults aged 20-49 years (p < 0.001). Pediatric CIED volumes were low, with several ICD, CRT, and CRTD procedures annually.
Conclusions:
CIED strategies in Japan demonstrate age-dependent variation. Epicardial systems remain indispensable in pediatric and congenital heart disease care, whereas alternative technologies are increasingly adopted in older adult populations, reflecting evolving lifespan-related device strategies.
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