Refurbished heart pacemakers work like new

CHICAGO — One person’s used pacemaker is another person’s treasure.

A program to refurbish used pacemakers could expand access to the lifesaving devices. In a clinical trial of nearly 300 people, patients who received refurbished pacemakers fared just as well as those who received new ones, scientists reported November 17 at the annual American Heart Association meeting.

The work could make pacemakers available to people who could not otherwise afford them, cardiac electrophysiologist Thomas Crawford said in a news briefing. The hope, he said, is to scale up the team’s operation and “deliver pacemakers to patients in low- and middle-income countries free of charge.”

Doctors use pacemakers to treat people with abnormal heartbeats (SN: 4/23/23) The tiny, battery-powered devices are typically implanted in the chest, with wires that thread through a vein and touch the heart. Electrical signals traveling down the wires kick the heart into a steady rhythm.

“We insert thousands and thousands of devices every year,” said Miguel Leal, a cardiac electrophysiologist at Emory University School of Medicine in Atlanta who was not involved with the work. But the devices are not equally available to patients. Annually in the United States, nearly 800 people per million receive pacemakers. In some countries, that number drops to the single digits.

Crawford sees two potential solutions. The first is designing low-cost pacemakers with basic functions. The second is what his team at the University of Michigan Medical School in Ann Arbor is trying: reusing old devices.

The U.S. Food and Drug Administration has approved pacemakers as single use devices. But today’s pacemakers can chug along for 15 years, sometimes outlasting their original owners. One such example inspired Crawford’s work: a patient who died two months after her pacemaker was implanted. Her husband later brought the device back to her doctors and said, “Can you use this in somebody else?”

“That was a completely eye-opening statement,” Crawford said. It led to his team’s program, called My Heart Your Heart, which collects pacemakers from people who have died or have had them removed. The team cleans and tests the devices and then donates them to patients in need.

In the study, Crawford’s team implanted either a new or refurbished pacemaker in participants in Venezuela, Nigeria, Paraguay, Kenya, Mozambique and Mexico and then tracked outcomes for 90 days. Results from people with either type of device looked nearly identical, the researchers found. Infection rates (a standard risk when implanting devices into the body) were similar in both groups ­­­— around 2 percent — and the team didn’t observe any device malfunctions. Three people with refurbished devices died over the time period studied, though none of the deaths were related to pacemaker malfunction, Crawford said.

Crawford estimates that refurbishing a pacemaker costs around $50 to $100. That’s compared to roughly $6,000 for a new one in the United States, and around $2,000 in the Global South, he said.

It will be important to follow up with participants to see if the refurbished devices continue to perform well, Leal said. But in a time when it can be difficult to promote equitable access to medical care, he said, Crawford’s work “is a great example of walking the walk and not just talking the talk.”