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Abstract
PURPOSE OF REVIEW The wearable defibrillator (WCD) was shown to be safe and effective in detecting and terminating ventricular tachyarrhythmias and therefore allows temporary protection from sudden cardiac death. This review gives an overview of the current data on WCD in newly diagnosed cardiomyopathy. RECENT FINDINGS Patients with newly diagnosed heart failure and reduced LVEF appear to have an increased risk of ventricular tachyarrhythmias, which may decrease over time when heart failure medication is optimized and left ventricular function improves. This was shown to apply for patients with ischemic and non-ischemic cardiomyopathy, including peripartum cardiomyopathy. Prolongation of the WCD period may support to further optimization of heart failure medication, by protecting the patient from sudden cardiac death during this time and to avoid untimely ICD implantation. The WCD should be considered in structured patient management for newly diagnosed heart failure during the early phase of the disease. Careful patient selection, structured patient management, and patient's compliance is crucial for a successful WCD strategy.
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Affiliation(s)
- David Duncker
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Christian Veltmann
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Kovacs B, Reek S, Krasniqi N, Eriksson U, Duru F. Extended Use of the Wearable Cardioverter-Defibrillator: Which Patients Are Most Likely to Benefit? Cardiol Res Pract 2018; 2018:7373610. [PMID: 30622822 PMCID: PMC6304887 DOI: 10.1155/2018/7373610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/18/2018] [Accepted: 10/28/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Wearable cardioverter-defibrillators (WCD, LifeVest, ZOLL) can protect from sudden cardiac death bridging a vulnerable period until a decision on implantable cardioverter-defibrillator (ICD) implantation can be reached. WCD is commonly used for 3 months or less. It is unknown, which patients use WCD longer and which patients are most likely to benefit from it. HYPOTHESIS Extended use of WCD is reasonable in selected cases based on underlying heart disease and overall patient risk profile. METHODS We conducted a systematic and comprehensive research of all published clinical studies on PubMed reporting on the use of the WCD. Only original articles reporting on wear times and time to appropriate shocks were included in our analysis. RESULTS The search resulted in 127 publications. 14 parameters were reported necessary for inclusion in our analysis. Median wear times ranged from 16 to 394 days. The median wear time was especially long for patients suffering from nonischemic cardiomyopathy (NICM) (range: 50-71 days) and specifically peripartum cardiomyopathy (PPCM) (120 days) and for heart transplant candidates. There was a large variation of appropriate shocks according to indication for WCD use. In contrast to NICM in general, the number of appropriate shocks was particularly high in patients with PPCM (0 in 254 patients and 5 in 49 patients, respectively). The median and maximal time periods to the first appropriate shock were longest in patients with PPCM (median time to the first appropriate shock: 68 days). CONCLUSIONS Prolonged use of WCD is not uncommon in available literature. Patients suffering from NICM and specifically PPCM seem most likely to have longer therapy duration with WCD with success. Careful patient selection for prolonged use may decrease the need for ICD implantation in the future; however, prospective data are needed to confirm this hypothesis.
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Affiliation(s)
- Boldizsar Kovacs
- Arrhythmias and Electrophysiology Unit, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Department of Cardiology, Regional Hospital Wetzikon, Spitalstrasse 66, 8620 Wetzikon, Switzerland
| | | | - Nazmi Krasniqi
- Department of Cardiology, Regional Hospital Wetzikon, Spitalstrasse 66, 8620 Wetzikon, Switzerland
| | - Urs Eriksson
- Department of Cardiology, Regional Hospital Wetzikon, Spitalstrasse 66, 8620 Wetzikon, Switzerland
| | - Firat Duru
- Arrhythmias and Electrophysiology Unit, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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53
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[Wearable defibrillator : Current evidence]. Herzschrittmacherther Elektrophysiol 2018; 29:362-368. [PMID: 30357452 DOI: 10.1007/s00399-018-0601-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
The wearable cardioverter/defibrillator (WCD) is safe and effective in the prevention of sudden cardiac death, and has found its way into international guidelines and clinical practice. Nearly 40,000 patients with a WCD have been published in clinical registries and one randomized study has recently been presented. Especially patients with newly diagnosed cardiomyopathy with severely reduced left ventricular function show an increased risk for ventricular tachyarrhythmias and may benefit from a WCD. In these patients without an indication for an implantable cardioverter-defibrillator (ICD), the WCD offers protection from sudden cardiac death during initiation and optimization of heart failure medication. Critical patient selection and structured patient management is crucial for successful WCD prescription. This review gives an overview of the current data and recommendations on WCD.
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54
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Jagadish PS, Aziz M, Chinta V, Khouzam RN. Misunderstood or Mistrusted? The Under-Utilization of the Wearable Cardioverter Defibrillator in Clinical Practice. Curr Probl Cardiol 2018; 45:100395. [PMID: 30340770 DOI: 10.1016/j.cpcardiol.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
Annually in the United States, sudden cardiac death (including out-of-hospital cardiac arrests) is responsible for over 300,000 deaths, comprising 40%-50% of total mortality rates from cardiovascular disease. Among the highest-risk patients are those with ischemic and nonischemic cardiomyopathy who have a reduced left ventricular ejection fraction (≤ 35%-40%). However, not everyone is a candidate for an implantable cardioverter defibrillator. In 2002, the wearable cardioverter defibrillator (WCD) gained Food and Drug Administration approval for its efficacy in the prevention of sudden cardiac arrest or death in certain at-risk populations and has been making its way into national guidelines with Class IIa to IIb strength of evidence. Despite the prevalence of sudden cardiac death and the demonstrated efficacy of the WCD, this technology remains under-prescribed. This study seeks to explicate the potential causes for under-utilization of WCDs and offer means of overcoming barriers to its use. Among these reasons include confusion about the guidelines and when to prescribe, who can prescribe the device, and debate about whether the WCD is efficacious based on recent studies. Other social barriers to prescription include cost and adherence to therapy by the patient. This study sets the stage for further research on the improvement of education about the device and opens discourse about its prescription in clinical practice.
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Affiliation(s)
- Michael E Field
- From the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.E.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (R.L.P.)
| | - Richard L Page
- From the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.E.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (R.L.P.)
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56
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Bossory L, Schubert S, Afzal MR, Weiss R, Tyler J, Kalbfleisch S, Augostini R, Hummel J, Okabe T, Daoud EG, Houmsse M. Clinical experience with wearable cardioverter defibrillators at a tertiary electrophysiology program. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1491-1494. [PMID: 30191582 DOI: 10.1111/pace.13491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/11/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A wearable cardioverter defibrillator (WCD) is an alternative for patients who are not immediate candidates for an implantable cardioverter defibrillator (ICD). METHODS Retrospective analysis of 242 patients prescribed a WCD from January 2014 through March 2015 with 1-year follow-up. RESULTS A WCD was prescribed to 242 patients during the 15-month period. Forty-one patients were excluded due to lack of complete follow-up. The remaining 201 patients received a WCD for primary or secondary prevention of SCD. Seventy-nine percent of WCDs were prescribed by nonelectrophysiologists. Underlying etiologies for the WCD prescription included: 38% nonischemic cardiomyopathy, 25% recent myocardial infarction, 16% newly diagnosed ischemic cardiomyopathy, 12% documented ventricular arrhythmia, 6% ICD lead extraction, and 3% had high risk conditions for sudden cardiac death. During 1-year follow-up, 96 patients (48%) received an ICD and five patients (2.5%) received appropriate shocks and one patient (0.5 %) received an inappropriate shock. Other 105 (52%) patients subsequently did not require an ICD due to either improvement in ejection fraction, refusal of ICD therapy, or death. CONCLUSIONS About half of patients prescribed a WCD subsequently receive an ICD and the rate of appropriate shock therapy from the WCD is 2.5%.
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Affiliation(s)
- Laurie Bossory
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Schubert
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Muhammad R Afzal
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jaret Tyler
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven Kalbfleisch
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph Augostini
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Hummel
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Toshimasa Okabe
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emile G Daoud
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Daimee UA, Vermilye K, Moss AJ, Goldenberg I, Klein HU, McNitt S, Zareba W, Kutyifa V. Experience with the wearable cardioverter-defibrillator in older patients: Results from the Prospective Registry of Patients Using the Wearable Cardioverter-Defibrillator. Heart Rhythm 2018; 15:1379-1386. [DOI: 10.1016/j.hrthm.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Indexed: 10/17/2022]
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Tate J, Stinstra J, Pilcher T, Poursaid A, Jolley MA, Saarel E, Triedman J, MacLeod RS. Measuring defibrillator surface potentials: The validation of a predictive defibrillation computer model. Comput Biol Med 2018; 102:402-410. [PMID: 30195579 DOI: 10.1016/j.compbiomed.2018.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 01/26/2023]
Abstract
Implantable cardioverter defibrillators (ICDs) are commonly used to reduce the risk in patients with life-threatening arrhythmias, however, clinicians have little systematic guidance to place the device, especially in cases of unusual anatomy. We have previously developed a computational model that evaluates the efficacy of a delivered shock as a clinical and research aid to guide ICD placement on a patient specific basis. We report here on progress to validate this model with measured ICD surface potential maps from patients undergoing ICD implantation and testing for defibrillation threshold (DFT). We obtained body surface potential maps of the defibrillation pulses by adapting a limited lead selection and potential estimation algorithm to deal with the limited space for recording electrodes. Comparison of the simulated and measured potential maps of the defibrillation shock yielded similar patterns, a typical correlation greater than 0.9, and a relative error less than 15%. Comparison of defibrillation thresholds also showed accurate prediction of the simulations. The high agreement of the potential maps and DFTs suggests that the predictive simulation generates realistic potential values and can accurately predict DFTs in patients. These validation results pave the way for use of this model in optimization studies prior to device implantation.
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Affiliation(s)
- Jess Tate
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA.
| | - Jeroen Stinstra
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
| | - Thomas Pilcher
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, USA
| | - Ahrash Poursaid
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
| | - Matthew A Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Elizabeth Saarel
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, USA
| | - John Triedman
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Rob S MacLeod
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
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Odeneg T, Ebner C, Mörtl D, Keller H, Dirninger A, Stix G, Föger B, Grimm G, Steinwender C, Gebetsberger F, Stühlinger M, Mastnak B, Haider C, Manninger M, Scherr D. Indications for and outcome in patients with the wearable cardioverter-defibrillator in a nurse-based training programme: results of the Austrian WCD Registry. Eur J Cardiovasc Nurs 2018; 18:75-83. [PMID: 30064269 DOI: 10.1177/1474515118790365] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The wearable cardioverter-defibrillator is a treatment option for patients at temporarily high risk of sudden cardiac death or in whom implantation of a cardioverter-defibrillator is temporarily not possible. OBJECTIVES The aim of this study was to provide real-world data on patients receiving this therapy in a nurse-based wearable cardioverter-defibrillator training programme. METHODS A registry including all patients prescribed with a wearable cardioverter-defibrillator in Austria between 2010 and 2016. Overall, 448 patients received a wearable cardioverter-defibrillator in 48 centres. Patients received structured nurse-based wearable cardioverter-defibrillator educational initial training followed by remote monitoring. RESULTS Main indications were: severe non-ischaemic cardiomyopathy (21%); recent myocardial infarction and percutaneous coronary intervention (20%); and stable coronary artery disease with percutaneous coronary intervention/coronary artery bypass grafting (14%). Eleven patients (2.5%) received 22 appropriate wearable cardioverter-defibrillator shocks. Two patients (0.4%) received three inappropriate shocks. The risk of sudden cardiac death varied between different aetiologies. Eight out of 11 (73%) patients received their first wearable cardioverter-defibrillator shock within 30 days. The main reasons for termination of the wearable cardioverter-defibrillator therapy were implantable cardioverter-defibrillator implantation (55.5%) and improvement of left ventricular ejection fraction to more than 35% (33%). CONCLUSION The wearable cardioverter-defibrillator is an effective and safe treatment option in patients at either transiently elevated risk of ventricular tachycardia/ventricular fibrillation or mandated postponed implantable cardioverter-defibrillator implantation, with a 2.5% shock rate over a median 54 days wearable cardioverter-defibrillator treatment period. However, both the wearable cardioverter-defibrillator shock rate and implantable cardioverter-defibrillator implantation rate vary widely depending on the wearable cardioverter-defibrillator indication. Nurse-based wearable cardioverter-defibrillator training is associated with high patient adherence, with a median wearing duration per day of 23.5 (1-24) hours.
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Affiliation(s)
- Tanja Odeneg
- 1 Department of Cardiology, Medical University of Graz, Austria
| | - Christian Ebner
- 2 Department of Cardiology, Elisabethinen Hospital Linz, Austria
| | - Deddo Mörtl
- 3 Department of Medicine, University Hospital St Poelten, Austria
| | - Hans Keller
- 4 Department of Medicine Rudolfstifung Vienna, Austria
| | | | - Günter Stix
- 6 Department of Cardiology, Medical University of Vienna, Austria
| | | | - Georg Grimm
- 8 Department of Medicine and Cardiology, Hospital Klagenfurt, Austria
| | - Clemens Steinwender
- 9 Department of Cardiology, Kepler University Hospital Linz, Austria.,10 Paracelsus Medical University Salzburg, Austria
| | | | | | | | | | | | - Daniel Scherr
- 1 Department of Cardiology, Medical University of Graz, Austria.,13 Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, The Netherlands
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Burger H, Schmitt J, Knaut M, Eitz T, Starck CT, Hakmi S, Siebel A, Böning A. Einsatz des tragbaren Kardioverter-Defibrillators nach kardiochirurgischen Eingriffen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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61
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Kutyifa V, Moss AJ, Klein HU, McNitt S, Zareba W, Goldenberg I. One-year follow-up of the prospective registry of patients using the wearable defibrillator (WEARIT-II Registry). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1307-1313. [PMID: 29992590 DOI: 10.1111/pace.13448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/02/2018] [Accepted: 03/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The WEARIT-II Registry demonstrated efficacy and safety of the wearable cardioverter defibrillator (WCD) for at-risk cardiac patients. However, 1-year outcomes in this population have not been reported. METHODS The WEARIT-II Registry enrolled 2,000 U.S. patients prescribed the WCD. One-year mortality data from start of WCD use were prospectively collected for 1,846 patients (93%). Outcome data were analyzed by disease etiology and implantable cardioverter defibrillator (ICD) implantation following WCD use. RESULTS During 12 months of follow-up, 73 patients died (4%). Kaplan-Meier survival analysis showed differences in all-cause mortality from WCD prescription between patients with ischemic versus nonischemic cardiomyopathy versus congenital/inherited heart disease (4% vs 3% vs 7%, P = 0.013). Patients with ventricular arrhythmia events during WCD use had a higher 1-year mortality (10% vs 3%, P = 0.042). Renal disease, increasing age, prior syncope, and nonbeta-blocker use predicted mortality. One-year mortality was similar in patients who did versus did not receive an ICD following WCD use in ischemic (3% vs 4%, P = 0.470) and nonischemic cardiomyopathy (3% vs 3%, P = 0.892). Patients with congenital/inherited heart disease with no implanted ICD had a trend toward a higher rate of mortality than those who received an ICD (8% vs 3%, P = 0.082). Multivariate models confirmed these findings. CONCLUSION One-year follow-up from the WEARIT-II Registry shows an overall good survival in patients prescribed the WCD. Short-term use of WCD allows appropriate risk stratification for decision on an ICD implantation in at-risk ischemic and nonischemic cardiomyopathy patients. Congenital/inherited heart disease patients had a higher risk of 1-year mortality even without an implanted ICD post-WCD.
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Affiliation(s)
- Valentina Kutyifa
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur J Moss
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Helmut U Klein
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McNitt
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Wojciech Zareba
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Ilan Goldenberg
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
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Spar DS, Bianco NR, Knilans TK, Czosek RJ, Anderson JB. The US Experience of the Wearable Cardioverter-Defibrillator in Pediatric Patients. Circ Arrhythm Electrophysiol 2018; 11:e006163. [PMID: 29945928 DOI: 10.1161/circep.117.006163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/15/2018] [Indexed: 11/16/2022]
Affiliation(s)
- David S. Spar
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (D.S.S., T.K.K., R.J.C., J.B.A.)
| | | | - Timothy K. Knilans
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (D.S.S., T.K.K., R.J.C., J.B.A.)
| | - Richard J. Czosek
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (D.S.S., T.K.K., R.J.C., J.B.A.)
| | - Jeffrey B. Anderson
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (D.S.S., T.K.K., R.J.C., J.B.A.)
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Sperzel J, Staudacher I, Goeing O, Stockburger M, Meyer T, Gonçalves ASO, Sydow H, Schoenfelder T, Amelung VE. Critical appraisal concerning "Wearable cardioverter defibrillators for the prevention of sudden cardiac arrest: a health technology assessment and patient focus group study". MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:201-204. [PMID: 29922100 PMCID: PMC5997130 DOI: 10.2147/mder.s165770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Johannes Sperzel
- Department of Cardiology, Hospital Kerckhoff Klinik GmbH, Bad Nauheim, Germany
| | - Ingo Staudacher
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Goeing
- Department of Cardiology, Sana-Hospital Lichtenberg, Berlin, Germany
| | | | - Thorsten Meyer
- Department of Public Health, Universität Bielefeld, Bielefeld, Germany
| | - Ana Sofia Oliveira Gonçalves
- Institute for Applied Health Services Research, inav - privates Institut für angewandte Versorgungsforschung GmbH, Berlin, Germany
| | - Hanna Sydow
- Institute for Applied Health Services Research, inav - privates Institut für angewandte Versorgungsforschung GmbH, Berlin, Germany
| | - Tonio Schoenfelder
- Institute for Applied Health Services Research, inav - privates Institut für angewandte Versorgungsforschung GmbH, Berlin, Germany
| | - Volker Eric Amelung
- Institute for Applied Health Services Research, inav - privates Institut für angewandte Versorgungsforschung GmbH, Berlin, Germany
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Nguyen E, Weeda ER, Kohn CG, D'Souza BA, Russo AM, Noreika S, Coleman CI. Wearable Cardioverter-defibrillators for the Prevention of Sudden Cardiac Death: A Meta-analysis. J Innov Card Rhythm Manag 2018; 9:3151-3162. [PMID: 32477809 PMCID: PMC7252786 DOI: 10.19102/icrm.2018.090506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/13/2018] [Indexed: 01/24/2023] Open
Abstract
Wearable cardioverter-defibrillators (WCDs) protect patients from sudden cardiac death (SCD) by detecting and treating life-threatening ventricular tachycardia/fibrillation (VT/VF). Recently, two large studies evaluating WCDs were published. However, the results of older and newer studies have yet to be systematically summarized. The objective of the current study was to conduct a meta-analysis assessing the use and effectiveness of WCDs. We searched MEDLINE and Scopus (January 1998–July 2017) as well as the gray literature. We included registry/observational studies that (1) evaluated adult patients using WCDs; (2) provided data on one or more outcomes of interest; and (3) were full-text studies published in English. We calculated pooled incidence and/or rate [with 95% confidence intervals (CIs)] estimates from nonoverlapping populations using a random-effects meta-analysis model. Statistical heterogeneity was assessed via the I2 statistic. We identified 11 studies (19,882 patients) with nonoverlapping populations/endpoints; seven of them evaluated WCD use across various indications, while the remaining studies restricted their focus to a single indication. Most of the studies were retrospective (82%) and multicenter (64%) in nature, with 45% using manufacturers’ registry data. The median duration of WCD use was three or more months in nine (82%) studies, and daily wear time ranged from a mean/median of 17 hours to 24 hours per day across included studies. Seven (64%) studies reported a mean/median daily wear time of more than 20 hours. This meta-analysis showed that the incidences of all-cause and SCD-related mortality among WCD patients were 1.4% (95% CI: 0.7%–2.4%) and 0.2% (95% CI: 0.1%–0.3%), respectively. VT/VF occurred in 2.6% (95% CI: 1.8%–3.5%) of patients. Across patients, 1.7% (95% CI: 1.4%–2.0%) received appropriate WCD treatment, corresponding to a rate of 9.1 patients/100 person-years (95% CI: 6.2–11.9 patients/100 person-years). Successful VT/VF termination following appropriate treatment occurred in 95.5% of patients (95% CI: 92.0%–98.0%) and the incidence of inappropriate treatment was infrequent (0.9%; 95% CI: 0.5%–1.4%). A moderate-to-high degree of statistical heterogeneity was observed in pooled analyses of mortality, VT/VF occurrence, and appropriate/inappropriate treatment (I2 ≥ 41% for all). In conclusion, WCDs appear to be successful in terms of terminating VT/VF in patients with an elevated risk of SCD and are appropriate for use while long-term risk management strategies are being identified.
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Affiliation(s)
- Elaine Nguyen
- Department of Pharmacy Practice, Idaho State University College of Pharmacy, Meridian, ID, USA
| | - Erin R Weeda
- Department of Pharmacy Practice, The Medical University of South Carolina, Charleston, SC, USA
| | - Christine G Kohn
- Department of Pharmacy Practice, University of Connecticut, Storrs, CT, USA
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Stacey Noreika
- Department of Pharmacy Practice, University of Connecticut, Storrs, CT, USA
| | - Craig I Coleman
- Department of Pharmacy Practice, University of Connecticut, Storrs, CT, USA
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65
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Zylla MM, Hillmann HAK, Proctor T, Kieser M, Scholz E, Zitron E, Katus HA, Thomas D. Use of the wearable cardioverter-defibrillator (WCD) and WCD-based remote rhythm monitoring in a real-life patient cohort. Heart Vessels 2018; 33:1390-1402. [PMID: 29721674 DOI: 10.1007/s00380-018-1181-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
Abstract
The wearable cardioverter-defibrillator (WCD) was introduced to provide protection from sudden cardiac death (SCD) in patients with transiently elevated risk or during ongoing risk stratification. Benefits and clinical characteristics of routine WCD use remain to be assessed in larger patient populations. This study aims to identify determinants of WCD compliance, therapies, and inappropriate alarms in a real-life cohort. A total of 106 cases (68.9% male) were included between 11/2010 and 04/2016. WCD therapies, automatically recorded arrhythmia episodes, inappropriate WCD alarms, patient compliance, and outcome after WCD prescription were analyzed. Median duration of WCD use was 58.5 days. Average daily wearing time was 22.7 h. Compliance was reduced in patients ≤ 50 years. Three patients received WCD therapies (2.8%). In one case ventricular fibrillation (VF) was appropriately terminated with the first shock. Two patients received inappropriate WCD therapies due to WCD algorithm activation during ventricular pacemaker stimulation. One patient died of asystole while carrying a WCD (0.9%). Additional arrhythmias detected comprised self-terminating sustained ventricular tachycardia (VT; 2.8%), non-sustained VT (2.8%), and supraventricular arrhythmias (5.7%). Inappropriate WCD alarms due to over-/undersensing occurred in 77/106 patients (72.6%), of which 41 (38.7%) experienced ≥ 10 inappropriate WCD alarms during the prescription period. Thirteen patients (12.3%) displayed a mean of > 1 inappropriate alarms/day. WCD use was associated with high compliance and provided protection from VT/VF-related SCD. The majority of patients experienced inappropriate WCD alarms. Alterations in QRS morphology during pacemaker stimulation require consideration in WCD programming to prevent inappropriate alarms.
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Affiliation(s)
- Maura M Zylla
- Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research) Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Henrike A K Hillmann
- Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Eberhard Scholz
- Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Edgar Zitron
- Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research) Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,DZHK (German Center for Cardiovascular Research) Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Liang JJ, Bianco NR, Muser D, Enriquez A, Santangeli P, D’Souza BA. Outcomes after asystole events occurring during wearable defibrillator-cardioverter use. World J Cardiol 2018; 10:21-25. [PMID: 29707164 PMCID: PMC5919889 DOI: 10.4330/wjc.v10.i4.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/20/2018] [Accepted: 04/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine whether wearable cardioverter defibrillator (WCD) alarms for asystole improve patient outcomes and survival.
METHODS All asystole episodes recorded by the WCD in 2013 were retrospectively analyzed from a database of device and medical record documentation and customer call reports. Events were classified as asystole episodes if initial presenting arrhythmia was asystole (< 10 beats/minor ≥ 5 s pause). Survival was defined as recovery at the scene or arrival to a medical facility alive, or not requiring immediate medical attention. Episodes occurring in hospitals, nursing homes, or ambulances were considered to be under medical care. Serious asystole episodes were defined as resulting in unconsciousness, hospital transfer, or death.
RESULTS Of the total 51933 patients having worn the WCD in 2013, there were 257 patients (0.5%) who had asystole episodes and comprised the study cohort. Among the 257 patients (74% male, median age 69 years), there were 264 asystole episodes. Overall patient survival was 42%. Most asystoles were considered “serious” (n = 201 in 201 patients, 76%), with a 26% survival rate. All 56 patients with “non-serious” asystole episodes survived. Being under medical care was associated with worse survival of serious asystoles. Among acute survivors, 20% later died during WCD use (a median 4 days post asystole episode). Of the 86 living patients at the end of WCD use period, 48 (56%) received ICD/pacemaker and 17 (20%) improved their condition.
CONCLUSION Survival rates after asystole in patients with WCD are higher than historically reported survival rates. Those under medical care at time of asystole exhibited lower survival.
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Affiliation(s)
- Jackson J Liang
- Department of Cardiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19103, United States
| | | | - Daniele Muser
- Department of Cardiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19103, United States
| | - Andres Enriquez
- Department of Cardiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19103, United States
| | - Pasquale Santangeli
- Department of Cardiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19103, United States
| | - Benjamin A D’Souza
- Department of Cardiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19103, United States
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Normand C, Linde C, Singh J, Dickstein K. Indications for Cardiac Resynchronization Therapy. JACC-HEART FAILURE 2018; 6:308-316. [DOI: 10.1016/j.jchf.2018.01.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 12/21/2022]
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Skowasch D, Ringquist S, Nickenig G, Andrié R. Management of sudden cardiac death in cardiac sarcoidosis using the wearable cardioverter defibrillator. PLoS One 2018; 13:e0194496. [PMID: 29566033 PMCID: PMC5864098 DOI: 10.1371/journal.pone.0194496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 03/05/2018] [Indexed: 01/29/2023] Open
Abstract
Background Patients with cardiac sarcoidosis are at increased risk of ventricular tachycardia/fibrillation. Objective We tested the hypothesis that the wearable cardioverter defibrillator can be used to mitigate the risk of sudden cardiac death among cardiac sarcoidosis patients. Methods A retrospective review of the commercial database identified cardiac sarcoidosis patients who wore the wearable cardioverter defibrillator. Evidence for cardiac sarcoidosis diagnosis as well as demographic, co-morbidity and left ventricular ejection fraction were provided by patient clinical records. Clinical data also included daily wearable cardioverter defibrillator wear, shock treatment and survival information. Results The wearable cardioverter defibrillator was worn by 46 cardiac sarcoidosis patients, 24 (52%) male. The median age was 48 years and median left ventricular ejection fraction was 30%. The wearable cardioverter defibrillator was worn a median of 23.6 hours each day. There were 11 ventricular tachycardia/fibrillation episodes occurring in 10 (22%) patients. Ventricular tachycardia/fibrillation occurred over a range of 1 to 79 days, median 24 days. First-shock success for conversion of ventricular tachycardia/fibrillation was 100%. Patient survival 24 hours after shock treatment was 100%. Follow up to determine the reason for discontinuing wearable cardioverter defibrillator use indicated that among shocked patients 7 received an implantable cardioverter defibrillator, 1 patient was admitted to the hospital ending in death 2 weeks after discontinuing wearable cardioverter defibrillator use, and 2 patients were lost to follow up. Among the not shocked patients, there were 16 who received an implantable cardioverter defibrillator while 7 achieved improved left ventricular ejection fraction. Conclusion Management of sudden cardiac death among cardiac sarcoidosis patients was aided by the wearable cardioverter defibrillator resulting in successful termination of ventricular tachycardia/fibrillation upon delivery of shock.
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Affiliation(s)
- Dirk Skowasch
- Department of Internal Medicine II, Division of Cardiology and Pneumology, University of Bonn, Bonn, Germany
- * E-mail:
| | | | - Georg Nickenig
- Department of Internal Medicine II, Division of Cardiology and Pneumology, University of Bonn, Bonn, Germany
| | - René Andrié
- Department of Internal Medicine II, Division of Cardiology and Pneumology, University of Bonn, Bonn, Germany
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Röger S, Rosenkaimer SL, Hohneck A, Lang S, El-Battrawy I, Rudic B, Tülümen E, Stach K, Kuschyk J, Akin I, Borggrefe M. Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting. BMC Cardiovasc Disord 2018; 18:52. [PMID: 29544442 PMCID: PMC5856002 DOI: 10.1186/s12872-018-0790-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/08/2018] [Indexed: 12/15/2022] Open
Abstract
Background The wearable cardioverter-defibrillator (WCD) has emerged as a valuable tool to temporarily protect patients at risk for sudden cardiac death (SCD). The aim of this study was to determine the value of the WCD for therapy optimization of heart failure patients. Methods One hundred five consecutive patients that received WCD between 4/2012 and 9/2016 were included in the study. All patients were followed for clinical outcome and echocardiographic parameters during WCD therapy and had continued follow-up after WCD therapy, irrespective of subsequent implantable cardioverter-defibrillator (ICD) implantation. Results The most common indication for WCD were newly diagnosed ischemic (ICM) or non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction (LVEF) ≤35%. Mean WCD wear time was 68.8 ± 50.4 days with a mean daily use of 21.5 ± 3.5 h. Five patients (4.8%) received a total of five appropriate WCD shocks. During WCD wear, patients with ICM and NICM showed significant improvement in LVEF, reducing the proportion of patients with a need for primary preventive ICD implantation to 54.8% (ICM) and 48.8% (NICM). An ICD was finally implanted in 51.4% of the study patients (24 trans-venous ICDs, 30 subcutaneous ICDs). After discontinuation of WCD therapy, all patients were followed for a mean of 18.6 ± 12.3 months. 5.6% of patients with implanted ICDs received appropriate therapies. No patient with subcutaneous ICD needed change to a trans-venous device. None of the patients without an implanted ICD suffered from ventricular tachyarrhythmias and no patient died suddenly. In patients with NICM a significant LVEF improvement was observed during long-term follow-up (from 34.8 ± 11.1% to 41.0 ± 10.2%). Conclusions WCD therapy successfully bridged all patients to either LVEF recovery or ICD implantation. Following WCD, ICD implantation could be avoided in almost half of the patients. In selected patients, prolongation of WCD therapy beyond 3 months might further prevent unnecessary ICD implantation. The WCD as an external monitoring system contributed important information to optimize device selection in patients that needed ICD implantation.
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Affiliation(s)
- Susanne Röger
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| | - Stefanie L Rosenkaimer
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Anna Hohneck
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Boris Rudic
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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70
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Weinstock J. Use of the Wearable Cardioverter Defibrillator as a Bridge to Implantable Cardioverter Defibrillator. Card Electrophysiol Clin 2018; 10:11-16. [PMID: 29428131 DOI: 10.1016/j.ccep.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The wearable cardioverter defibrillator has been shown to be effective in terminating ventricular arrhythmias in patients at risk for sudden cardiac death. There are numerous scenarios in which implant of a permanent implantable cardioverter defibrillator is temporarily contraindicated or not advisable and a wearable cardioverter defibrillator may be beneficial. There are no prospective randomized studies published that provide conclusive guidance toward the use of the wearable cardioverter defibrillator, and thus, patient management needs to be individualized based on the available data.
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Affiliation(s)
- Jonathan Weinstock
- Department of Medicine, Division of Cardiology, Tufts University School of Medicine, Cardiac Arrhythmia Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02118, USA.
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71
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Boey E, Kojodjojo P. Optimal Strategies for Mitigating Sudden Cardiac Death Risk in At-risk Patients with Structural Heart Disease. J Innov Card Rhythm Manag 2018; 9:3025-3032. [PMID: 32494485 PMCID: PMC7252838 DOI: 10.19102/icrm.2018.090204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/29/2017] [Indexed: 12/03/2022] Open
Abstract
This article reviews the strategies used to mitigate sudden death risks in at-risk patients with structural heart disease. The roles of implantable and non-implantable technologies to prevent arrhythmic death are discussed.
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Affiliation(s)
- Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Pipin Kojodjojo
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore,Address correspondence to: Pipin Kojodjojo, PhD, National University Heart Centre, 1E Kent Ridge Road, National University Health System Tower Block, Level 9, Singapore 119228.
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72
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Niwano S, Sekiguchi Y, Ishii Y, Iwasaki Y, Kato R, Okamura H, Takagi M, Kurita T, Nitta T. Clinical Usefulness of Wearable Cardioverter Defibrillator (WCD) and Current Understanding of Its Clinical Indication in Japan. Circ J 2018; 82:1481-1486. [PMID: 29445060 DOI: 10.1253/circj.cj-17-1336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prevention of sudden cardiac death (SCD) has become an important issue in today's cardiovascular field, together with various developments in secondary prevention of basic cardiac diseases. The importance of the implantable cardioverter defibrillator (ICD) is now widely accepted because it has exhibited significant improvement in patients' prognoses in ischemic and non-ischemic cardiovascular diseases. However, there is an unignorable gap between the ICD indication in the guidelines and real-world high-risk patients for SCD, especially in the acute recovery phase of cardiac injury. Although various studies have demonstrated a clinical benefit of defibrillation devices, the studies of immediate ICD use in the acute recovery phase have failed to exhibit a benefit in patients from the point of the view of a decrease in total deaths. To bridge this gap, the wearable cardioverter defibrillator (WCD) provides a safer observation period in the acute phase and eliminates inappropriate overuse of ICD in the subacute phase. Here, we discuss the usefulness of the WCD and current understanding of its indications based on various clinical data. In conclusion, WCD is a feasible bridge to therapy and/or safe observation for patients at high risk of SCD, especially in the acute recovery phase of cardiac diseases.
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Affiliation(s)
- Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Yuki Iwasaki
- The Department of Cardiovascular Medicine, Nippon Medical School
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University, International Medical Center
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Hospital Organization, Wakayama Hospital
| | | | | | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
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73
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Ellenbogen KA, Wan C, Shavelle DM. Outcome of Patients With In-Hospital Ventricular Tachycardia and Ventricular Fibrillation Arrest While Using a Wearable Cardioverter Defibrillator. Am J Cardiol 2018; 121:205-209. [PMID: 29153771 DOI: 10.1016/j.amjcard.2017.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
In-hospital sudden cardiac arrests occurring during nighttime and weekend hours or within unmonitored hospital areas have been reported to have a poorer outcomes than monitored cardiac arrest. This study sought to assess the outcome of in-hospital ventricular tachycardia (VT) and ventricular fibrillation (VF) arrest by time of day, day of week, and within-hospital location when using a wearable cardioverter defibrillator (WCD). We retrospectively identified and reviewed consecutive in-hospital VT/VF arrests from January 2011 to May 2015 experienced by patients wearing a WCD using the manufacturer's postmarket registry. An index shockable sudden cardiac arrest event was defined as the first arrest caused by VT/VF. Event location and clinical outcome were extracted from patient call logs. Survival analysis was performed using the Kaplan-Meier method. A total of 234 in-hospital VT/VF arrests were included (mean age = 65 ± 12 years, male = 74%); 50% had a history of congestive heart failure. The median follow-up time was 6 days (interquartile range 1-4). In the 128 (55%) daytime events (7:00 a.m. to 7:00 p.m.), 24-hour survival was 91%. The 106 (45%) nighttime events (7:01 p.m. to 6:59 a.m.) had 89% 24-hour survival (p = 0.54). Survival outcome by monitored or unmonitored hospital locations were similar. Kaplan-Meir analyses showed no difference in 30-day survival either between weekend and weekday events (72% vs 65%, p = 0.79), or between daytime and nighttime events (64% vs 69%, p = 0.37). In conclusion, WCD use during in-hospital VT/VF arrest correlated with high survival rates regardless of event time or location inside a hospital. Use of a WCD appears to mitigate some of the risks associated with in-hospital VT/VF arrest.
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74
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Agarwal M, Narcisse D, Khouzam N, Khouzam RN. Wearable Cardioverter Defibrillator "The Lifevest": Device Design, Limitations, and Areas of Improvement. Curr Probl Cardiol 2017; 43:45-55. [PMID: 29277221 DOI: 10.1016/j.cpcardiol.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sudden cardiac death is a potentially fatal clinical event demanding use of emergent intervention such as defibrillation. Over the last 1 decade, development of devices such as implantable and wearable cardioverter defibrillators (WCD) has provided new avenues in the management of sudden cardiac death. Several clinical studies have commented on the therapeutic and preventive aspect of WCD, however, literature describing the device functioning and limitations is limited. In this review study, we describe the technical aspects and limitations of WCD with a focus on identifying potential areas of improvement and framework for future research studies.
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75
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Schlitt A, Guha M, Noutsias M, Klein HH, Klein HU. [Patients with a wearable cardioverter-defibrillator (WCD) : Prescription, function and rehabilitation support]. Herz 2017; 44:379-389. [PMID: 29234842 DOI: 10.1007/s00059-017-4650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/07/2017] [Indexed: 11/27/2022]
Abstract
Assessment of a permanent risk of life-threatening ventricular arrhythmia in patients with severely reduced left ventricular ejection fraction (LVEF <35%), e. g. after myocarditis, dilated cardiomyopathy, acute myocardial infarction, in patients with postpartum cardiomyopathy or implantable cardioverter-defibrillator (ICD) and cardiac resynchronization treatment plus defibrillator (CRT-D) infection with temporary explantation of the system is a medical challenge. This is time-consuming and unsafe because life-threatening ventricular arrhythmias may occur during the time of risk assessment. During this phase of risk stratification, a wearable cardioverter-defibrillator (WCD) is indicated. The WCD, which is usually worn by the patient for several months, combines continuous retrievable electrocardiogram (ECG) recordings with a reliable defibrillation capability. The prescription of a WCD guarantees safe rehabilitation procedures for patients following acute inpatient treatment. Rehabilitation measures in patients with a WCD are indicated because of the underlying systolic cardiac insufficiency due to severe myocardial disease. In almost half of the patients, who are potentially threatened by ventricular tachyarrhythmias or sudden cardiac death (SCD), the LVEF and heart failure symptoms improve under controlled medication within a few months. Thus, the risk of SCD is lowered so that in many cases a first line ICD implantation is no longer necessary. The purpose of this article is to provide recommendations for rehabilitation procedures of patients with a WCD. A review of the currently available data on WCD publications was carried out with special emphasis on the current national and international guidelines.
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Affiliation(s)
- A Schlitt
- Paracelsus-Harz-Klinik Bad Suderode, Paracelsusstr. 1, 06485, Quedlinburg, Deutschland.
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - M Guha
- Reha-Klinik am Sendesaal, Bremen, Deutschland
| | - M Noutsias
- Mitteldeutsches Herzzentrum, Klinik für Innere Medizin III (KIM-III) - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | | | - H U Klein
- Medical Center, University of Rochester, Rochester, USA
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Abstract
The Centers for Diseases Control and Prevention estimates that 5.7 million adults in the United States suffer from heart failure and 1 in 9 deaths in 2009 cited heart failure as a contributing cause. Almost 50% of patients who are diagnosed with heart failure die within 5 years of diagnosis. Cardiovascular disease is a public health burden. The prognosis of patients with heart failure has improved significantly. However, the risk for death remains high. Managing sudden death risk and intervening appropriately with primary or secondary prevention strategies are of paramount importance.
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Affiliation(s)
- Basil Saour
- Department of Internal Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, 420 E Superior Street, Chicago, IL 60611, USA
| | - Bryan Smith
- Department of Internal Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, 420 E Superior Street, Chicago, IL 60611, USA
| | - Clyde W Yancy
- Department of Internal Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, 420 E Superior Street, Chicago, IL 60611, USA.
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77
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Experience With Wearable Cardioverter-Defibrillators at 2 Academic Medical Centers. JACC Clin Electrophysiol 2017; 4:231-239. [PMID: 29749943 DOI: 10.1016/j.jacep.2017.09.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study sought to characterize the experience in a cohort of patients prescribed a wearable cardioverter-defibrillator (WCD) over a 2-year interval at 2 academic medical centers. BACKGROUND The WCD is available for patients felt to be at high risk of sudden cardiac death. However, there is a lack of randomized data to guide its use and prescribing patterns vary. METHODS We retrospectively reviewed indications and therapies of all WCD prescriptions over a 2-year period from 2 large academic medical centers. Data on compliance and treatment events of patients wearing the WCD were reviewed. RESULTS Among the 147 patients prescribed a WCD, 80% were male with an age of 59 ± 14 years. The WCD was prescribed for the following reasons: primary prevention in the setting of a left ventricular ejection fraction ≤35% (53%), secondary prevention when an implantable cardioverter-defibrillator was not implanted (16%), implantable cardioverter-defibrillator explantation (23%), and other high-risk scenarios for arrhythmic sudden death (9%). The median wear duration was 50 days (interquartile range [IQR]: 25 to 85 days) with a median of 21.0 h of wear per day (IQR: 15.0 to 22.8 h). High-voltage treatment was delivered in 3 separate patients, 2 of whom died. The third patient received 3 WCD shocks without restoration of a perfusing rhythm and ultimately was resuscitated by emergency responders. No patients received inappropriate therapies. CONCLUSIONS Events requiring therapy were rare and no lives were directly saved by the WCD. Future efforts are needed to improve identification of patients most likely to benefit from a WCD.
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Naniwadekar A, Alnabelsi T, Joshi K, Obasare E, Greenspan A, Mainigi S. Real world utilization and impact of the wearable cardioverter-defibrillator in a community setting. Indian Pacing Electrophysiol J 2017; 17:65-69. [PMID: 29072998 PMCID: PMC5478916 DOI: 10.1016/j.ipej.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/12/2016] [Accepted: 01/07/2017] [Indexed: 11/07/2022] Open
Abstract
Introduction The wearable cardioverter-defibrillator (WCD) is used in patients at risk for sudden cardiac death (SCD) but not immediate candidates for intracardiac defibrillator (ICD) implantation. Methods We performed a single center retrospective study of patients prescribed WCD upon hospital discharge from January 2002 to October 2015. Clinical characteristics were obtained from the hospital electronic database and device data from Zoll LifeVest database. Results Of 140 patients, 62% were men, 85.9% were African-American and mean age was 58.2 ± 15.5 years. Ischemic cardiomyopathy was present in 45 (32%) and non-ischemic cardiomyopathy in 64 patients (46%). Mean left ventricular ejection fraction (EF) was 0.28 ± 0.4. WCD was worn for 7657 patient-days (21 patient-years), with each patient using WCD for median of 43 days (IQR: 7–83 days), and daily mean use 17.3 ± 7.5 h. There were a total of 6 (4.2%) WCD shocks of which 2 (1.4%) were appropriate (one for VT, one for VF) and 4 (2.8%) were inappropriate (2 had supraventricular tachycardia, 2 had artifact). Two patients who received appropriate shocks were African-American with non-ischemic cardiomyopathy (EF<20%), non-sustained VT and wide QRS duration. Upon termination of WCD use, 45 (32%) received ICD while EF improved in 34 patients (32%). Conclusions In a predominantly minority, community setting, WCD compliance is high and use is effective in aborting SCD. However, inappropriate shocks do occur. A significant proportion of patients did not ultimately require ICD implantation suggesting this may be a cost-effective strategy in patients at risk of SCD.
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Affiliation(s)
- Aditi Naniwadekar
- The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States.
| | - Talal Alnabelsi
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Kamal Joshi
- The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States
| | - Edinrin Obasare
- The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States
| | - Allan Greenspan
- The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States
| | - Sumeet Mainigi
- The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States
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Reek S, Burri H, Roberts PR, Perings C, Epstein AE, Klein HU, Lip G, Gorenek B, Sticherling C, Fauchier L, Goette A, Jung W, Vos MA, Brignole M, Elsner C, Dan GA, Marin F, Boriani G, Lane D, Blomström-Lundqvist C, Savelieva I. The wearable cardioverter-defibrillator: current technology and evolving indications. Europace 2017; 19:335-345. [PMID: 27702851 DOI: 10.1093/europace/euw180] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The wearable cardioverter-defibrillator has been available for over a decade and now is frequently prescribed for patients deemed at high arrhythmic risk in whom the underlying pathology is potentially reversible or who are awaiting an implantable cardioverter-defibrillator. The use of the wearable cardioverter-defibrillator is included in the new 2015 ESC guidelines for the management of ventricular arrhythmias and prevention of sudden cardiac death. The present review provides insight into the current technology and an overview of this approach.
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Affiliation(s)
- Sven Reek
- Electrophysiology Service, Hirslanden Klinik Aarau, Aarau, Switzerland.,Rhythmologie Aargau, Rain 34, CH-5000 Aarau, Switzerland
| | - Haran Burri
- Cardiology Service, University Hospital of Geneva, Geneva, Switzerland
| | - Paul R Roberts
- Cardiac Rhythm Management, University Hospital Southampton, Southampton, UK
| | | | - Andrew E Epstein
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Helmut U Klein
- University of Rochester Medical Center, Heart Research Follow up Program, Rochester, NY, USA
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Defibrillation for Ventricular Fibrillation: A Shocking Update. J Am Coll Cardiol 2017; 70:1496-1509. [PMID: 28911514 DOI: 10.1016/j.jacc.2017.07.778] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023]
Abstract
Cardiac arrest is defined as the termination of cardiac activity associated with loss of consciousness, of spontaneous breathing, and of circulation. Sudden cardiac arrest and sudden cardiac death (SCD) are terms often used interchangeably. Most patients with out-of-hospital cardiac arrest have shown coronary artery disease or symptoms during the hour before the event. Cardiac arrest is potentially reversible by cardiopulmonary resuscitation, defibrillation, cardioversion, cardiac pacing, or treatments targeted at the underlying disease (e.g., acute coronary occlusion). We restrict SCD hereafter to cardiac arrest due to ventricular fibrillation, including rhythms shockable by an automatic external defibrillator (AED), implantable cardioverter-defibrillator (ICD), or wearable cardioverter-defibrillator (WCD). We summarize the state of the art related to defibrillation in treating SCD, including a brief history of the evolution of defibrillation, technical characteristics of modern AEDs, strategies to improve AED access and increase survival, ancillary treatments, and use of ICDs or WCDs.
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81
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Harris JR, Carlson SK, Wolfson AM, Saxon LA, Doshi RN. Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia. HeartRhythm Case Rep 2017; 3:348-351. [PMID: 28748142 PMCID: PMC5511983 DOI: 10.1016/j.hrcr.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | - Rahul N. Doshi
- Division of Cardiology EP Section, University of Southern California Keck School of Medicine, Los Angeles, California
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Barraud J, Cautela J, Orabona M, Pinto J, Missenard O, Laine M, Thuny F, Paganelli F, Bonello L, Peyrol M. Wearable cardioverter defibrillator: Bridge or alternative to implantation? World J Cardiol 2017; 9:531-538. [PMID: 28706588 PMCID: PMC5491470 DOI: 10.4330/wjc.v9.i6.531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/04/2017] [Accepted: 04/20/2017] [Indexed: 02/06/2023] Open
Abstract
The implantable cardioverter-defibrillator (ICD) is effective to prevent sudden cardiac death (SCD) in selected patients with heart disease known to be at high risk for ventricular arrhythmia. Nevertheless, this invasive and definitive therapy is not indicated in patients with potentially transient or reversible causes of sudden death, or in patients with temporary contra-indication for ICD placement. The wearable cardioverter defibrillator (WCD) is increasingly used for SCD prevention both in patients awaiting ICD implantation or with an estimated high risk of ventricular arrhythmia though to be transient. We conducted a review of current clinical uses and benefits of the WCD, and described its technical aspects, limitations and perspectives.
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84
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Beiert T, Malotki R, Kraemer N, Stöckigt F, Linhart M, Nickenig G, Schrickel JW, Andrié RP. A real world wearable cardioverter defibrillator experience - Very high appropriate shock rate in ischemic cardiomyopathy patients at a European single-center. J Electrocardiol 2017; 50:603-609. [PMID: 28499628 DOI: 10.1016/j.jelectrocard.2017.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) has emerged as a valuable tool to protect patients with increased risk of sudden cardiac death (SCD). We sought to characterize WCD patients and to analyze predictors of ventricular arrhythmia (VA) occurrence and WCD shock delivery. METHODS AND RESULTS One hundred fourteen patients with WCD use were included in the study. Indications were mainly ischemic cardiomyopathy (ICM; 31.6%), non-ICM (45.6%) and explantation of implantable cardioverter defibrillator due to device infection (11.4%). We observed sustained VA in 9.6% of the study population and 6.1% received an appropriate shock. VA occurred in 16.7% of ICM, 3.8% of non-ICM and 15.4% of patients with device infection. CONCLUSIONS Our data demonstrate a very high rate of sustained VA in patients at risk for SCD during WCD use. ICM patients, including those with recent MI, bore the highest risk.
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Affiliation(s)
- Thomas Beiert
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany.
| | - Robert Malotki
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Natalie Kraemer
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Florian Stöckigt
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Markus Linhart
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Jan W Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - René P Andrié
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
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Wan C, Szymkiewicz SJ, Klein HU. The impact of body mass index on the wearable cardioverter defibrillator shock efficacy and patient wear time. Am Heart J 2017; 186:111-117. [PMID: 28454824 DOI: 10.1016/j.ahj.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The impact of body mass index (BMI) on the shock efficacy and patient adherence among patients using a wearable cardioverter defibrillator (WCD) is unknown. METHODS Patients prescribed the WCD between January 1, 2008 and June 1, 2013, who experienced at least one episode of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and who received appropriate WCD therapy, were identified within a registry maintained by the manufacturer for regulatory, reimbursement, and administrative purposes. The registry contained patients' Body Mass Index (BMI) which was categorized as normal (18.0<BMI<25.0), overweight (25.0≤BMI<30.0) or obese (30.0≥BMI). Demographics, indication for WCD prescription and other clinical information were reviewed. Device-stored ECG, transthoracic impedance (TTI) and time worn were downloaded for analyses. A post-shock rhythm which was no longer VT or VF was considered a successful tachyarrhythmia conversion. Only the first-shock arrhythmia conversion and TTI were included in the analyses. RESULTS A total of 574 patients were included in the final analyses. Patient characteristics were similar across all groups except the obese group (60±11 years) was younger than the normal (63±16 years) and overweight (64±12 years, P=.001) groups. Mean length of use for normal, overweight and obese groups was 79±131, 82±202 and 55±97 days (P=.12), respectively; the median daily wear time was 21 hours among all groups. In a total of 623 VT/VF events, the median TTI was 44 ohms, 51 ohms and 65 ohms for normal, overweight and obese groups, respectively; TTI was positively correlated to BMI (r=0.33, P<.01). First-shock conversion rate was 92.9% in the normal group, 93.6% and 93.9% in the overweight and obese groups, respectively (P=.93). There was no difference in 24-hour survival among the three groups (91.9%, 94.1% and 92.3%, P=.66). CONCLUSION The WCD first-shock success rate and post-event 24-hour survival were high and independent from BMI. TTI was positively correlated with BMI but did not impact early clinical outcome. WCD was safe to all BMI groups and the patient wear time was excellent across all groups.
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86
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Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis. Clin Res Cardiol 2017; 106:582-589. [PMID: 28275862 PMCID: PMC5529484 DOI: 10.1007/s00392-017-1090-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/09/2017] [Indexed: 01/15/2023]
Abstract
Introduction Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy characterized by an acute reduction in left ventricular ejection fraction (LVEF). Sudden deaths during the course of PPCM are reported to be elevated, the underlying mechanisms remains unknown. The aim of the present multi-centre study was to evaluate the arrhythmia burden in a multi-centre approach in patients with PPCM using a wearable cardioverter/defibrillator (WCD). Methods and results Forty-nine patients from 16 German centres with newly diagnosed PPCM and LVEF ≤35% receiving a WCD were included in this retrospective analysis. Mean follow-up was 15 ± 10 months. At diagnosis, mean age was 33 ± 5 years, parity was 2.1 ± 1.6, LVEF was 21 ± 7%, NYHA functional class was 3.4 ± 0.7. Mean wear time was 120 ± 106 days, mean wear time per day was 21.4 ± 3.3 h. Six (12%) patients presented eight ventricular tachyarrhythmias during WCD period: five episodes of VF, two sustained ventricular tachycardia (VT) and one non-sustained VT occurred. Conclusion This multicentre study underpins the elevated risk for ventricular tachyarrhythmias in patients with newly diagnosed PPCM and reduced LVEF. A WCD should be considered for 3–6 months in these patients to prevent sudden cardiac death from ventricular tachyarrhythmias.
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87
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Mitigating Post-Extraction Risk. JACC Clin Electrophysiol 2017; 3:251-252. [DOI: 10.1016/j.jacep.2016.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 11/21/2022]
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Ellenbogen KA, Koneru JN, Sharma PS, Deshpande S, Wan C, Szymkiewicz SJ. Benefit of the Wearable Cardioverter-Defibrillator in Protecting Patients After Implantable-Cardioverter Defibrillator Explant. JACC Clin Electrophysiol 2017; 3:243-250. [DOI: 10.1016/j.jacep.2016.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 11/26/2022]
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Hai JJ, Tam E, Chan PH, Lau CP, Siu CW, Tse HF. Incidence and predictors of sudden arrhythmic death or ventricular tachyarrhythmias after acute coronary syndrome: An asian perspective. Heart Rhythm 2017; 14:81-87. [DOI: 10.1016/j.hrthm.2016.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Indexed: 12/22/2022]
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90
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The wearable defibrillator. Curr Opin Cardiol 2017; 32:39-46. [DOI: 10.1097/hco.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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91
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Sasaki S, Shoji Y, Ishida Y, Kinjo T, Tsushima Y, Seno M, Nishizaki F, Itoh T, Izumiyama K, Yokota T, Yokoyama H, Yamada M, Horiuchi D, Kimura M, Higuma T, Tomita H, Okumura K. Potential roles of the wearable cardioverter-defibrillator in acute phase care of patients at high risk of sudden cardiac death: A single-center Japanese experience. J Cardiol 2017; 69:359-363. [DOI: 10.1016/j.jjcc.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/21/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022]
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Affiliation(s)
- Byron K Lee
- From University of California, San Francisco, Department of Medicine, Division of Cardiology.
| | - Jeffrey E Olgin
- From University of California, San Francisco, Department of Medicine, Division of Cardiology
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93
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Schmitt J, Abaci G, Johnson V, Erkapic D, Gemein C, Chasan R, Weipert K, Hamm CW, Klein HU. Safety of the Wearable Cardioverter Defibrillator (WCD) in Patients with Implanted Pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 40:271-277. [PMID: 27943296 DOI: 10.1111/pace.12986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/19/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is an important approach for better risk stratification, applied to patients considered to be at high risk of sudden arrhythmic death. Patients with implanted pacemakers may also become candidates for use of the WCD. However, there is a potential risk that pacemaker signals may mislead the WCD detection algorithm and cause inappropriate WCD shock delivery. The aim of the study was to test the impact of different types of pacing, various right ventricular (RV) lead positions, and pacing modes for potential misleading of the WCD detection algorithm. METHODS Sixty patients with implanted pacemakers received the WCD for a short time and each pacing mode (AAI, VVI, and DDD) was tested for at least 30 seconds in unipolar and bipolar pacing configuration. In case of triggering the WCD detection algorithm and starting the sequence of arrhythmia alarms, shock delivery was prevented by pushing of the response buttons. RESULTS In six of 60 patients (10%), continuous unipolar pacing in DDD mode triggered the WCD detection algorithm. In no patient, triggering occurred with bipolar DDD pacing, unipolar and bipolar AAI, and VVI pacing. Triggering was independent of pacing amplitude, RV pacing lead position, and pulse generator implantation site. CONCLUSION Unipolar DDD pacing bears a high risk of false triggering of the WCD detection algorithm. Other types of unipolar pacing and all bipolar pacing modes do not seem to mislead the WCD detection algorithm. Therefore, patients with no reprogrammable unipolar DDD pacing should not become candidates for the WCD.
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Affiliation(s)
- Joern Schmitt
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Guezine Abaci
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Victoria Johnson
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Damir Erkapic
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Christopher Gemein
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Ritvan Chasan
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Kay Weipert
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Christian W Hamm
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany.,Abteilung für Kardiologie, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Helmut U Klein
- Heart Research Follow Up Program, University Hospital of Rochester Medical Center, Rochester, New York
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Jin D, Dai C, Gong Y, Lu Y, Zhang L, Quan W, Li Y. Does the choice of definition for defibrillation and CPR success impact the predictability of ventricular fibrillation waveform analysis? Resuscitation 2016; 111:48-54. [PMID: 27951401 DOI: 10.1016/j.resuscitation.2016.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Quantitative analysis of ventricular fibrillation (VF), such as amplitude spectral area (AMSA), predicts shock outcomes. However, there is no uniform definition of shock/cardiopulmonary resuscitation (CPR) success in out-of-hospital cardiac arrest (OHCA). The objective of this study is to investigate post-shock rhythm variations and the impact of shock/CPR success definition on the predictability of AMSA. METHODS A total of 554 shocks from 257 OHCA patients with VF as initial rhythm were analyzed. Post-shock rhythms were analyzed every 5s up to 120s and annotated as VF, asystole (AS) and organized rhythm (OR) at serial time intervals. Three shock/CPR success definitions were used to evaluate the predictability of AMSA: (1) termination of VF (ToVF); (2) return of organized electrical activity (ROEA); (3) return of potentially perfusing rhythm (RPPR). RESULTS Rhythm changes occurred after 54.5% (N=302) of shocks and 85.8% (N=259) of them occurred within 60s after shock delivery. The observed post-shock rhythm changes were (1) from AS to VF (24.9%), (2) from OR to VF (16.1%), and (3) from AS to OR (12.1%). The area under the receiver operating characteristic curve (AUC) for AMSA as a predictor of shock/CPR success reached its maximum 60s post-shock. The AUC was 0.646 for ToVF, 0.782 for ROEA, and 0.835 for RPPR (p<0.001) respectively. CONCLUSIONS Post-shock rhythm is unstable in the first minute after the shock. The predictability of AMSA varies depending on the definition of shock/CPR success and performs best with the return of potentially perfusing rhythm endpoint for OHCA.
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Affiliation(s)
- Danian Jin
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China; Information Department, The 303th Hospital of PLA, Nanning, Guangxi 530021, China
| | - Chenxi Dai
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yushun Gong
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yubao Lu
- Emergency Department, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Lei Zhang
- Emergency Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Weilun Quan
- ZOLL Medical Corporation, Chelmsford, MA 01824, USA
| | - Yongqin Li
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China.
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Erath JW, Vamos M, Sirat AS, Hohnloser SH. The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients. Clin Res Cardiol 2016; 106:300-306. [PMID: 27888304 DOI: 10.1007/s00392-016-1054-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/17/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The wearable cardioverter-defibrillator (WCD) is used for temporary protection of patients deemed to be at high risk for sudden death (SCD) not yet meeting indications for the implantable defibrillator (ICD). OBJECTIVES To evaluate the efficacy, safety, and compliance of/to WCD use and subsequent medium-term outcome of patients in a single-center observational study. METHODS A total of 102 consecutive patients were fitted with the WCD from 2012 to 2015 and followed for a mean of 11 months (±8 months). RESULTS The most common clinical indication for WCD-prescription (63%) was a new diagnosis of severely impaired LV function (LVEF ≤35%). The median wear time of the WCD was 54 days with a daily use of 23 h. Appropriate WCD therapy occurred in four patients (seven shocks for VF, one shock for VT). An ICD was finally implanted in 56 patients (55%). Improvement in LV function was the most common reason not to implant an ICD (HR 0.37; 95% CI 0.19-0.73; p = 0.004). Two patients had inappropriate shocks from their WCD due to atrial fibrillation/flutter. Five patients fitted with an ICD after the end of WCD therapy suffered VT/VF episodes. After wearing the WCD, six patients died (five ICD recipients and one non-ICD recipient). CONCLUSION WCD therapy was well accepted by patients and provided temporary protection against ventricular tachyarrhythmias in patients at risk for SCD. The WCD may help to avoid unnecessary ICD implantations in a significant proportion of patients.
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Affiliation(s)
- Julia W Erath
- Goethe University Hospital, Frankfurt, Hessen, Germany.
| | - Mate Vamos
- Goethe University Hospital, Frankfurt, Hessen, Germany
| | - Abdul Sami Sirat
- Goethe University Hospital, Frankfurt, Hessen, Germany
- Helios Klinikum Siegburg, Siegburg, Germany
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Abstract
The use of implantable cardioverter defibrillators (ICD) has favorably impacted the prevention and treatment of sudden cardiac death (SCD) associated with ventricular arrhythmias. However, there are situations where an ICD cannot be immediately implanted, even though the patient is at high risk for SCD. The wearable cardioverter defibrillator (WCD) is a unique technology that can bridge this gap for patients. The WCD has been demonstrated to terminate ventricular tachycardia/fibrillation if worn and used correctly. With proper training, it is relatively easy to put on, maintain, and use. Most patients are compliant and are able to consistently wear the device. The WCD negates the infection risk or procedural complications associated with insertion and possible extraction of leads, as with an ICD. In terms of primary prevention of ventricular tachycardia/fibrillation in patients with a left ventricular ejection fraction ≤35%, prospective, randomized studies evaluating the survival of patients utilizing the WCD will need to be performed before evidenced-based criteria for its use can be established. On the basis of current data, WCD use for those awaiting heart transplant, for those with ICD indications status post-ICD explant, and for high-risk SCD patients with possible reversible cardiomyopathy appears to be a reasonable approach on the basis of current data.
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97
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Ozlu MF, Barsheshet A, Moss AJ, Goldenberg I, Kutyifa V, Biton Y, McNitt S, Zareba W, Aktas MK. Time Dependence of Ventricular Tachyarrhythmias After Myocardial Infarction. JACC Clin Electrophysiol 2016; 2:565-573. [DOI: 10.1016/j.jacep.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 04/08/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
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99
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Duncker D, Bauersachs J, Veltmann C. [The wearable cardioverter/defibrillator : Temporary protection from sudden cardiac death]. Internist (Berl) 2016; 57:864-70. [PMID: 27465560 DOI: 10.1007/s00108-016-0110-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In the majority of cases sudden cardiac death (SCD) is caused by ventricular tachyarrhythmia. Implantable cardioverter-defibrillators (ICD) represent an evidence-based and established method for prevention of SCD. For patients who do not fulfill the criteria for guideline-conform implantation of an ICD but still have an increased, e.g. transient risk for SCD, a wearable cardioverter-defibrillator (WCD) vest was developed to temporarily prevent SCD. Numerous studies have shown the safety and efficacy of the WCD, although there is still a gap in evidence concerning a reduction in overall mortality and improvement in prognosis. This article gives an overview on the currently available literature on WCD, the indications, potential risks and complications.
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Affiliation(s)
- D Duncker
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Veltmann
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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100
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Wäßnig NK, Günther M, Quick S, Pfluecke C, Rottstädt F, Szymkiewicz SJ, Ringquist S, Strasser RH, Speiser U. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death. Circulation 2016; 134:635-43. [PMID: 27458236 PMCID: PMC4998124 DOI: 10.1161/circulationaha.115.019124] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/27/2016] [Indexed: 12/18/2022]
Abstract
Supplemental Digital Content is available in the text. Background: This study evaluated the wearable cardioverter-defibrillator (WCD) for use and effectiveness in preventing sudden death caused by ventricular tachyarrhythmia or fibrillation. Methods: From April 2010 through October 2013, 6043 German WCD patients (median age, 57 years; male, 78.5%) were recruited from 404 German centers. Deidentified German patient data were used for a retrospective, nonrandomized analysis. Results: Ninety-four patients (1.6%) were treated by the WCD in response to ventricular tachyarrhythmia/fibrillation. The incidence rate was 8.4 (95% confidence interval, 6.8–10.2) per 100 patient-years. Patients with implantable cardioverter-defibrillator explantation had an incidence rate of 19.3 (95% confidence interval, 12.2–29.0) per 100 patient-years. In contrast, an incidence rate of 8.2 (95% confidence interval, 6.4–10.3) was observed in the remaining cardiac diagnosis groups, including dilated cardiomyopathy, myocarditis, and ischemic and nonischemic cardiomyopathies. Among 120 shocked patients, 112 (93%) survived 24 hours after treatment, whereas asystole was observed in 2 patients (0.03%) with 1 resulting death. ConclusionS: This large cohort represents the first nationwide evaluation of WCD use in patients outside the US healthcare system and confirms the overall value of the WCD in German treatment pathways.
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Affiliation(s)
- Nadine K Wäßnig
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.).
| | - Michael Günther
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Silvio Quick
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Christian Pfluecke
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Fabian Rottstädt
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Steven J Szymkiewicz
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Steven Ringquist
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Ruth H Strasser
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
| | - Uwe Speiser
- From Technische Universität Dresden, Heart Center Dresden, University Hospital, Department of Internal Medicine and Cardiology, Dresden, Germany (N.W., M.G., S.Q., C.P., F.R., R.S., U.S.); and ZOLL, Pittsburgh, PA (S.S., S.R.)
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