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Abstract
Unanticipated pacemaker and implantable cardioverter-defibrillator (ICD) generator
malfunctions sometimes warrant recall by the US Food and Drug Administration (FDA).
Despite increasingly frequent device implantation, pacemaker and ICD recalls and safety
alerts (advisories) remain poorly characterized.
To determine pacemaker and ICD generator advisory rates in the United States, to identify
trends in these rates, and to examine their clinical and financial implications.
Analysis of weekly FDA Enforcement Reports issued between January 1990 and December
2000 to identify all advisories involving pacemaker or ICD generators in the United
States. Recalls and safety alerts involving lead malfunctions were not included.
Number of pacemakers and ICD generators in the United States subject to FDA recall
or safety alert in 1990-2000; annual pacemaker and ICD advisory rates in the United
States in 1990-2000; and estimated cost of device advisories.
During the study period, 52 advisories (median [25th and 75th percentiles], 4 [4 and
7] per year) involving 408 500 pacemakers and 114 645 ICDs (523 145 total devices)
were issued. Hardware malfunctions (35 advisories affecting 280 641 devices) and computer
errors (10 advisories affecting 216 533 devices) accounted for 95% of device recalls.
Implantable cardioverter-defibrillators were recalled more frequently than pacemakers
(mean [SD], 16.4 [1.6] vs 6.7 [0.8] advisories per 100 person-years; P<.001). Between
1995 and 2000, the annual advisory rate increased for both pacemakers (P for trend
<.001) and ICDs (P for trend =.02). An estimated 1.3 million device checks and analyses
and 36 187 device replacements resulted from the advisories and cost approximately
$870 million.
Pacemaker and ICD recalls and safety alerts occur frequently, affect many patients,
and appear to be increasing in number and rate. With the growing number of device
implants and expanding indications for device therapy, the number of patients affected
by device advisories will likely continue to increase.