The widespread, easy availability of AEDs shall be the turning point of this stagnant market.

With defibrillators becoming more prevalent in communities, and with the greater public awareness of their value, the number of deaths each year from sudden cardiac arrest can be dramatically reduced. It is hoped that, eventually, AEDs will become as easily available as fire extinguishers: on display everywhere and able to be used by anyone in an emergency.

With modern technology and the investment in R&D for defibrillators, it won't be too long before defibrillator will be something one could carry in their pocket. No doubt they will soon be the size of a mobile phone device.

Indian Market Dynamics

Indian Defibrillators Market Value-Wise Total Rs. 86 CroreThe Indian market for defibrillators in 2014 is estimated as 6430 units, at Rs.86 crore. The year saw an estimated 20 percent decline in monophasic defibrillators, which was offset by 20 percent increase in biphasic ones. The AED increased 10 percent in 2014, over 2013. This is in volume terms.

The prices over the last couple of years have fallen drastically. Chinese products are infiltrating the market, and finding their way into smaller new hospitals and nursing homes being set up.

The government procurement is also largely determined by the extremely low prices quoted by the vendors. Some orders placed included 125 units by HLL (for AIIMS), 29 units of multichannel monitors and defibrillators, 100 units of AEDs by Tamil Nadu Medical Services Corporation Limited, and 100 defibrillators by Andhra Pradesh government.

Schiller and Philips continue to dominate this segment, with a combined share in the vicinity of 70 percent. With the recent launch of Efficia DFM100 defibrillator in the value segment, Philips has further strengthened its position in this segment. The brand also offers Goldway products, having acquired all outstanding shares of in Shenzhen Goldway Industrial, Inc. in 2008. BPL (largely monophasic), Medtronic (largely AEDs) and Nihon Kohden (largely biphasic) are aggressive in this segment. Other popular brands are Zoll, Mindray, GE, Cardiac Science (marketed by AMDL), and Metrax.

Indian Defibrillators Market Unit-Wise Total 6430 UnitsGaining popularity are those models, which also offer an external pacemaker, and have ready-for-use indicators, and where remote monitoring is possible. The industry expects the segment to get major impetus once the government takes a decision to provide widespread access to AEDs in community settings as primary health centers, buses, bus stops, schools, malls, recreation facilities, office buildings, and other public locations.

Technology Advancements

There have been several recent advancements in implantable cardioverter defibrillator (ICD) technology to extend battery life, improvements in patient monitoring to avoid needless shocks, the introduction of quadripolar lead devices to improve device programming and to improve therapy effectiveness, and development of magnetic resonance imaging (MRI)-safe ICDs.

Battery life. Battery longevity has long been an issue with ICDs. As patients live longer, they may need to undergo surgical procedures every few years for regular battery replacements. Increased device longevity can reduce the risk of infection and other complications due to repeat replacement procedures and help minimize out-of-pocket patient expenses for avoidable replacement procedures. In February, Boston Scientific launched a line of extended longevity (EL) battery ICDs, including the Dynagen EL and Inogen EL device models. The EL ICD is an important advancement that can help minimize the frequency of avoidable replacement procedures to help reduce costs and the potential for replacement-related complication.

Quadripolar leads expand therapy options. One of the biggest innovations has been the introduction of quadripolar lead devices. Leading Vendors in Indian Defibrillators Market 2014The leads use four electrodes to allow more programming options for pacing and overcoming issues with lead placement. This can help optimize CRT-D therapy and decrease the number of patients who do not respond. Up to 10 percent of heart failure patients' left ventricular (LV) lead placements are not successful because of anatomical challenges, phrenic nerve stimulation (PNS) or poor electrical measurement. Use of a quadripolar LV lead instead of a bipolar option during CRT can decrease complications at six months, according to preliminary results presented at the 2014 European Society of Cardiology (ESC) Congress. Presented at Heart Rhythm 2014, the hospitalization rates and associated cost analysis of quadripolar versus bipolar CRT-D: a comparative analysis of a single-center prospective Italian registry presentation, demonstrated quadripolar leads reduced the number of hospitalizations by 53 percent when compared to the non-quadripolar group.

Way Forward

Dr PC Manoria, Director, Manoria Heart &Critical Care Hospital, Bhopal

"Automatic implantable cardiac defibrillator (AICD) has proved to be a very effective device for preventing SCD but there are two unmet needs associated with it. One is the venous access problems and the second is it cannot be implanted in individuals who are temporarily predisposed for SCD. The subcutaneous implantable cardiac defibrillator (S-ICD) has fulfilled the first unmet need while the wearable defibrillator has solved the second one. Both S-ICD and wearable defibrillators are very exciting new devices knocking at the door of defibrillator technology.”

Dr PC Manoria
Manoria Heart &Critical Care Hospital, Bhopal

Although conventional ICDs have proved effective in the prevention of sudden cardiac death, they still appear to be limited by non-trivial acute and long-term complications. The recent advent of an entirely subcutaneous ICD (S-ICD) represents a further step in the evolution of defibrillation technology towards a less-invasive approach.

However, future research and design improvements are still required to address various aspects. For example, a pediatric model of the S-ICD to be used in small children (e.g., < 8 years, < 30 kg) may be an alternative option in the future. Ongoing improvements in detection algorithms, as with the recent algorithm to avoid TWOS, should further improve S-ICD performance and reduce inappropriate therapies. Finally, the integration of the S-ICD system with leadless pacing, if proved feasible, could play an important role in defibrillation technology enabling the expansion of the less invasive S-ICD therapy to a larger cohort of ICD population.

Indian Market Dynamics is based on market research conducted by Medical Buyer in November 2015

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