The wearable cardioverter-defibrillator vest: Indications and ongoing questions

Wearable cardioverter-defibrillator (life-vest): A feasible bridging treatment in adult congenital heart disease

Background

Wearable cardioverter-defibrillators (WCDs) are currently used in patients at temporarily heightened risk for sudden cardiac death (SCD) who are temporarily unable to receive an implantable cardioverter-defibrillator (ICD). WCD can safely record and terminate life-threatening arrhythmias through a non-invasive electrode-based system. The current clinical indications for WCD use are varied and keep evolving as experience with this technology increases.

Methods

We reviewed and explored the data behind indications for WCD use and discuss its usefulness in congenital heart disease (CHD) patients.

Results

We considered 8 consecutive patients (mean age 35.25 years, range 18–51 years, average duration of WCD use 4 months, range 3–6 months) with complex CHD, in which a WCD was used between June 2018 and January 2022. No sustained ventricular arrhythmias requiring shocks were recorded in the observation period. No inappropriate shocks were recorded. All the patients showed a good compliance and a very high mean wear time per day (21.2 ± 1 h a day). Four patients implanted a permanent device (3 CRT-D, 1 ICD), three underwent cardiac surgery at the end of the WCD period and one is still on the waiting list for the operation.

Conclusions

Larger trial could confirm the possible conceivable benefit from an extended use of the WCD in certain populations with complex CHD as in our case series, especially in patients with life-treating ventricular arrhythmias waiting for surgery for residual cardiac defects or in the early phases following the surgical/hemodynamic interventions, patients with tachycardiomyopathy expected to improve after the arrhythmias are removed and patients awaiting implantation of an ICD at high risk due to active infection.

The Prognostic Value of Early Repolarization Pattern for the Ventricular Tachyarrhythmias of Acute Myocardial Infarction Patients: A Meta-Analysis

Several studies have indicated that early repolarization (ER) is a risk factor for ventricular tachyarrhythmias (VTAs) in acute myocardial infarction (AMI) patients. The prognostic values of ER detail characteristics except J-point morphology, and inferior leads ER location for VTAs are still unclear. We searched PubMed, Embase, and the Cochrane Library for eligible studies up to March 4, 2019. Studies to investigate the relationship between ER and the incidence of VTAs in AMI patients were extracted. A total of 10 studies with 2,672 participants were included in the analysis. ER significantly predicted the incidence of VTAs (odds ratio [OR] 3.62, 95% confidence intervals [CI] 2.77-4.73), regardless of the type of AMI. The presence of ER before AMI (OR 5.58, 95% CI 3.41 to 9.12) and after AMI (OR 3.02, 95% CI 2.19-4.15) increased the risk of VTAs. The prognostic value of ER for VTAs in the long follow-up (≥30 days) (OR 2.39, 95% CI 1.59-3.59) fell by half compared to the short follow-up duration (<30 days) (OR 4.97, 95% CI 3.48-7.09). Patients with ER displayed a higher risk of developing ventricular fibrillation (VF) (OR 6.94, 95% CI 3.87-12.43) than those without ER. However, neither J-point elevation with OR = 2.48 nor lateral leads' ER location with OR = 3.83 remarkably increased the risk of VTAs in patients with AMI. ER is significantly associated with increasing risk of VTAs, particularly VF, in AMI patients. This relationship is weaker in the 30-day follow-up and is not reinforced by J-point elevation and lateral leads' ER location.