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When Implanted Heart Devices Fail

The Odds -- and Consequences -- of Pacemaker, ICD Breakdowns

ICD Replacement Risks continued...

"Let's say a man had a first heart attackheart attack three years ago, and the doctor advised him that his risk of sudden death is 2% to 5% per year," Krahn says. "If that patient has device put in and finds out there is a 1-in-1,000 chance the device will not be reliable, the patient may say leave that alone. If, on the other hand, that patient received a shock three months ago, and the doctor says, 'We checked the device, it saved your life,' then the patient may want a new one, because his life clearly depends on it working."

Wilkoff agrees that patients must carefully consider whether to replace an ICD because of an advisory.

"It turns out that changing the device is not necessarily the lower-risk answer," he says. "We shouldn't overreact to the realization these remarkably effective devices aren't perfect. Maisel found a 1%-2% malfunction rate, not death risk. But in the ICD population, there is a 7% to 15% annual risk of death without a device. Is the ICD perfect? No. But we cannot have people panicking about this when there are much bigger devils sitting outside their doors."

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