Cardiac Rhythm Management Devices: Model-Specific Guidance on Pacemakers, ICDs, CRT-Ds, and CRT-Ps

March 1, 2013 | Evaluations & Guidance


The synchronized transmission of electricity through the heart causes the heart to beat in a coordinated manner, and a breakdown of this electrical system leads to serious, often life-threatening heart rhythms known as arrhythmias. Cardiac rhythm management (CRM) devices treat a range of cardiac conditions stemming from electrical system problems. Implanted CRM devices include pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy defibrillators (CRT-Ds), and cardiac resynchronization therapy pacemakers (CRT-Ps).

Many hospitals wish to decrease costs by reducing the number of CRM device models and suppliers they must deal with. In order to do this, however, it is necessary to understand the differences and similarities between these models and suppliers—which is anything but simple. For example, there are many features designed to address similar physiologic situations, but some of these features have vague or confusing names, and it can be hard to keep track of what each one does.

This article can provide a starting point for comparing the features of different models and suppliers. It serves as a companion to our February 2012 Guidance Article “Without Missing a Beat: A Primer on Cardiac Rhythm Management Devices.” While the previous article encouraged facilities to select one or a few models that are appropriate for most patients for bulk-purchasing negotiation, this article can help you identify models that offer feature sets to meet the needs of specific patient subpopulations.

Below, we provide descriptions of the current CRM devices from four major manufacturers—Biotronik, Boston Scientific, Medtronic, and St. Jude Medical—and discuss the key differences among them. Devices are divided into three tiers within each product line:

In the “notable features” sections following each device-category discussion, we include a list of special capabilities that may be useful for certain patients, along with the models that offer them. This information may be useful when looking for a model to meet an individual patient’s needs; inclusion on these lists doesn’t necessarily mean that these models are better choices than other models for the majority of patients.

We also discuss a couple of the recent developments in...

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