From the Guidelines
The medical term for pacemaker battery end of life is Elective Replacement Indicator (ERI). This is the point at which the pacemaker's battery has reached a predetermined voltage level that indicates replacement should be scheduled soon, but is not yet critically depleted. When a pacemaker reaches ERI status, it typically has about 3-6 months of battery life remaining before reaching End of Service (EOS), which represents complete battery depletion. During the ERI phase, the pacemaker may automatically switch to a more energy-conserving mode with reduced functionality to extend the remaining battery life. This gives physicians and patients adequate time to schedule a generator replacement procedure before the device fails completely. Regular follow-up appointments with cardiac device specialists are essential to monitor battery status and detect when a pacemaker has reached ERI, as patients typically do not experience symptoms when the battery begins to deplete 1.
Some key points to consider when a pacemaker reaches ERI include:
- The decision to replace or not replace a pacemaker is complex and should be individualized based on the patient's specific needs and circumstances 1
- Discontinuation of pacemaker therapy may be reasonable in patients who present for pacemaker pulse generator replacement, or for management of pacemaker-related complications, in whom the original pacing indication has resolved or is in question 1
- The process required to discontinue pacing therapy is unclear, and options for discontinuation of pacemaker therapy could include programming the pacemaker “off,” elective nonreplacement of a device approaching end of battery service life, explant of the pulse generator alone, and in some cases, pulse generator explant and extraction of the lead(s) 1.
Overall, the management of pacemaker battery end of life requires careful consideration of the patient's individual needs and circumstances, as well as regular follow-up appointments to monitor battery status and detect when a pacemaker has reached ERI.
From the Research
Pacemaker Battery End of Life
The medical term for pacemaker battery end of life is referred to as the Elective Replacement Indicator (ERI) 2, 3, 4, 5, 6.
Definition and Purpose
- The ERI is a feature designed to indicate when a pacemaker's battery is nearing the end of its life, prompting the need for replacement 2, 3, 4.
- The ERI is intended to provide a warning before the pacemaker's battery is completely depleted, allowing for scheduled replacement and minimizing the risk of sudden device failure 6.
Factors Influencing ERI
- Battery depletion indicators, such as cell impedance, can be used to estimate the remaining service life of a pacemaker, but may not always accurately predict the timing of ERI 2.
- Factors like pacing rate, device model, and patient dependence on the pacemaker can influence the timing and occurrence of ERI 3, 4.
Clinical Implications
- The appearance of ERI can trigger an abrupt change to backup mode, potentially compromising pacemaker-dependent patients with low programmed basic pacing rates 2.
- Close monitoring and replacement of the pacemaker before ERI is recommended to prevent complications, especially in patients with high pacing rates or those who are pacemaker-dependent 2, 3.