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Rohrer U, Manninger M, Fiedler L, Steinwender C, Binder RK, Stühlinger M, Zirngast B, Zweiker D, Zirlik A, Scherr D. Prevention of Early Sudden Cardiac Death after Myocardial Infarction Using the Wearable Cardioverter Defibrillator-Results from a Real-World Cohort. J Clin Med 2023; 12:5029. [PMID: 37568431 PMCID: PMC10419414 DOI: 10.3390/jcm12155029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND After acute myocardial infarction (AMI), patients are at risk of sudden cardiac death. The VEST trial failed to show a reduction in arrhythmic mortality in AMI patients with an LVEF ≤ 35% prescribed with a WCD, having a lower-than-expected WCD wearing compliance. OBJECTIVES The aim was to investigate on outcomes of patients in a real-world Austrian cohort with good compliance. METHODS A retrospective analysis of all eligible Austrian WCD patients according to the VEST trial inclusion and exclusion criteria between 2010 and 2020 was performed. RESULTS In total, 105 Austrian patients (64 ± 11 years, 12% female; LVEF 28 ± 6%) received a WCD for a median of 69 (1; 277) days after AMI (wearing duration 23.5 (0; 24) hours/day). Within the first 90 days, 4/105 (3.8%) patients received 9 appropriate shocks (2 (1; 5) shocks). No inappropriate shocks were delivered, and 3/105 (2.9%) patients died during follow-up. Arrhythmic mortality (1.9% Austria vs. 1.6% VEST, p = 0.52), as well as all-cause mortality (2.9% vs. 3.1%, p = 0.42) was comparable in both cohorts. CONCLUSIONS The WCD is a safe treatment option in a highly selected cohort of patients with LVEF ≤ 35% after AMI. However, despite excellent WCD wearing duration in our cohort, the arrhythmic mortality rate was not significantly different.
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Affiliation(s)
- Ursula Rohrer
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria (D.S.)
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria (D.S.)
| | - Lukas Fiedler
- Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria
- Division of Cardiology, Department of Medicine, University Hospital Salzburg, 5020 Salzburg, Austria
| | - Clemens Steinwender
- Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital Linz, 4020 Linz, Austria
| | - Ronald K. Binder
- Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, 4710 Grieskirchen, Austria
| | - Markus Stühlinger
- Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, 6020 Innsbruck, Austria
| | - Birgit Zirngast
- Division of Cardiac Surgery, Medical University of Graz, 8036 Graz, Austria
| | - David Zweiker
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria (D.S.)
| | - Andreas Zirlik
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria (D.S.)
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria (D.S.)
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Aidelsburger P, Seyed-Ghaemi J, Guinin C, Fach A. Effectiveness, efficacy, and safety of wearable cardioverter-defibrillators in the treatment of sudden cardiac arrest - Results from a health technology assessment. Int J Technol Assess Health Care 2020; 36:1-9. [PMID: 32600490 DOI: 10.1017/s0266462320000379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the effectiveness, efficacy, and safety of a wearable cardioverter-defibrillator (WCD) in adult persons with high risk for sudden cardiac arrest and for which an implantable cardioverter is currently not applicable. METHODS We performed a systematic literature search in Medline, Embase, Cochrane Library, and CRD-databases. Study selection was performed by two reviewers independently. Data were presented quantitatively; due to heterogeneity of studies no meta-analysis was performed. RESULTS One randomized-controlled trial (RCT), one non-randomized comparative trial, and forty-four non-comparative trials were included. The RCT reported an overall mortality of 3.1 percent in the WCD group versus 4.9 percent in controls (relative risk [RR]: .64; 95 percent confidence interval [CI], .43-.98, p = .04), but no significant effect on arrhythmia-related mortality. The RR for arrhythmia-related mortality amounted to .67 (95 percent CI, .37-1.21, p = .18) as assessed in the RCT. Appropriate shocks were observed in 1.3 percent of patients in both comparative studies, and inappropriate shocks in .6 percent of patients in the RCT. Termination of ventricular tachycardia (VT) or ventricular fibrillation (VF) was successful in 75 to 100 percent of appropriate shocks in all studies. Adverse events assessed in the RCT showed a lower incidence of shortness of breath (38.8 percent vs. 45.3 percent; p = .004), higher incidence of rash at any location (15.3 percent vs. 7.1 percent; p < .001), and higher incidence of itching at any location (17.2 percent vs. 6.4 percent; p < .001) for WCD. CONCLUSIONS Available evidence demonstrates that the WCD detects and terminates VT/VF events reliably and shows a high rate of appropriate shocks in mixed patient populations. Data of large registries confirm that the WCD is a safe intervention.
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Masri A, Altibi AM, Erqou S, Zmaili MA, Saleh A, Al-Adham R, Ayoub K, Baghal M, Alkukhun L, Barakat AF, Jain S, Saba S, Adelstein E. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2019; 5:152-161. [PMID: 30784684 PMCID: PMC6383782 DOI: 10.1016/j.jacep.2018.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study sought to synthesize the available evidence on the use of the wearable cardioverter-defibrillator (WCD). BACKGROUND Observational WCD studies for the prevention of sudden cardiac death have provided conflicting data. The VEST (Vest Prevention of Early Sudden Death) trial was the first randomized controlled trial (RCT) showing no reduction in sudden cardiac death as compared to medical therapy only. METHODS We searched PubMed, EMBASE, and Google Scholar for studies reporting on the outcomes of patients wearing WCDs from January 1, 2001, through March 20, 2018. Rates of appropriate and inappropriate WCD therapies were pooled. Estimates were derived using DerSimonian and Laird's method. RESULTS Twenty-eight studies were included (N = 33,242; 27 observational, 1 RCT-WCD arm). The incidence of appropriate WCD therapy was 5 per 100 persons over 3 months (95% confidence interval [CI]: 3.0 to 6.0, I2 = 93%). In studies on ischemic cardiomyopathy, the appropriate WCD therapy incidence was lower in the VEST trial (1 per 100 persons over 3 months; 95% CI: 1.0 to 2.0) as compared with observational studies (11 per 100 persons over 3 months; 95% CI: 11.0 to 20.0; I2 = 93%). The incidence of inappropriate therapy was 2 per 100 persons over 3 months (95% CI: 1.0 to 3.0; I2 = 93%). Mortality while wearing WCD was rare at 0.7 per 100 persons over 3 months (95% CI: 0.3 to 1.7; I2 = 94%). CONCLUSIONS The rate of appropriately treated WCD patients over 3 months of follow-up was substantial; higher in-observational studies as compared with the VEST trial. There was significant heterogeneity. More RCTs are needed to justify continued use of WCD in primary prevention.
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Affiliation(s)
- Ahmad Masri
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Ahmed M Altibi
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sebhat Erqou
- Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mohammad A Zmaili
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ala Saleh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raed Al-Adham
- Department of Medicine, University of Arizona, Phoenix, Arizona
| | - Karam Ayoub
- Division of Cardiology, Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Moaaz Baghal
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laith Alkukhun
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Evan Adelstein
- Division of Cardiology, Albany Medical College, Albany, New York
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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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[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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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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