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Kreimer F, Koepsel K, Gotzmann M, Kovacs B, Dreher TC, Blockhaus C, Klein N, Kuntz T, Shin DI, Lapp H, Rosenkaimer S, Abumayyaleh M, Hamdani N, Saguner AM, Erath JW, Duru F, Beiert T, Schiedat F, Weth C, Custodis F, Akin I, Mügge A, Aweimer A, El-Battrawy I. Predictors of ventricular tachyarrhythmia in patients with a wearable cardioverter defibrillator: an international multicenter registry. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01869-w. [PMID: 38985244 DOI: 10.1007/s10840-024-01869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND AIMS Wearable cardioverter defibrillator (WCD) can protect patients from sudden cardiac death due to ventricular tachyarrhythmias and serve as a bridge to decision of definite defibrillator implantation. The aim of this analysis from an international, multicenter WCD registry was to identify predictors of sustained ventricular tachycardia (VT) and/or ventricular fibrillation (VF) in this population. METHODS One thousand six hundred seventy-five patients with WCD were included in a multicenter registry from 9 European centers, with a median follow-up of 440 days (IQR 120-893). The primary study end point was the occurrence of sustained VT/VF. RESULTS Sustained VT was detected by WCD in 5.4% and VF in 0.9% of all patients. Of the 30.3% of patients receiving ICD implantation during follow-up, sustained VT was recorded in 9.3% and VF in 2.6%. Non-ischemic cardiomyopathy (HR 0.5, p < 0.001), and medication with angiotensin-converting enzyme inhibitors (HR 0.7, p = 0.027) and aldosterone antagonists (HR 0.7, p = 0.005) were associated with a significantly lower risk of VT/VF. CONCLUSIONS Patients who received WCD due to a transient increased risk of sudden cardiac death have a comparatively lower risk of VT/VF in the presence of non-ischemic cardiomyopathy. Of note, optimal medical treatment for heart failure not only results in an improvement in left ventricular ejection fraction but also in a reduction in the risk for VT/VF.
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Affiliation(s)
- Fabienne Kreimer
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
- Department of Cardiology, University Hospital Münster, Münster, Germany
| | - Katharina Koepsel
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Michael Gotzmann
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Boldizsar Kovacs
- Department of Cardiology University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952, Schlieren, Switzerland
| | - Tobias C Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Blockhaus
- Department of Cardiology Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Norbert Klein
- Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Leipzig, Germany
| | - Thomas Kuntz
- Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Leipzig, Germany
| | - Dong-In Shin
- Department of Cardiology Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Hendrik Lapp
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Nazha Hamdani
- Institute of Physiology, Department of Cellular and Translational Physiology and Institut Für Forschung Und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany
| | - Ardan Muammer Saguner
- Department of Cardiology University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952, Schlieren, Switzerland
| | - Julia W Erath
- Department of Cardiology, Frankfurt University Hospital Goethe University, Frankfurt Am Main, Germany
| | - Firat Duru
- Department of Cardiology University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952, Schlieren, Switzerland
| | - Thomas Beiert
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
- Department of Cardiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Christian Weth
- Department of Internal Medicine II, Klinikum Saarbruecken, Saarbruecken, Germany
| | - Florian Custodis
- Department of Internal Medicine II, Klinikum Saarbruecken, Saarbruecken, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Andreas Mügge
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
- Institute of Physiology, Department of Cellular and Translational Physiology and Institut Für Forschung Und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany.
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Handling SCD risk in adult congenital heart disease: Should we InVEST in the WCD? Indian Pacing Electrophysiol J 2022; 22:223-224. [PMID: 36064259 PMCID: PMC9463464 DOI: 10.1016/j.ipej.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nägele H, Groene E, Stierle D, Ali Khan M, Nägele MP. Experience with a Wearable Cardioverter-defibrillator in 436 Patients. J Innov Card Rhythm Manag 2022; 13:4856-4862. [PMID: 35127240 PMCID: PMC8812478 DOI: 10.19102/icrm.2022.130104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to review the safety and efficiency of wearable cardioverter-defibrillators (WCDs) under current guideline-directed medical therapy (GDMT). We retrospectively analyzed 436 consecutive WCD patients seen in the years 2014–2020. Detected automatic arrhythmia alarm (AA) episodes were validated and classified as correct or incorrect. The positive predictive value (PPV) was calculated. GDMT was optimized in our outpatient clinic to maximal tolerated doses. During a total wear time (WT) of 23,527 days, 3,135 AAs were transmitted from 206 of 436 (47.2%) patients. Visual analysis revealed correct diagnoses of non-sustained ventricular tachycardia (VT) in 38 AAs from 6 patients (total PPV, 1.21%; PPV in VT patients, 41%); the remaining AAs were artifacts. No appropriate or inappropriate shocks and fatalities were recorded. LVEF significantly improved (P < .001) during the WT from 25% (range, 20%–30%) to 40% (range, 34%–46%). Defibrillators were implanted in 109 patients (27%). The PPV for VT of the WCD was very low. There were fewer instances of true VT than previously reported, and no shocks (appropriate or inappropriate) were delivered. The majority of patients greatly improved with GDMT, and device implantation rates were lower than previously reported. Improvements in arrhythmia detection algorithms are warranted. Based on our results, WCDs are rarely needed for lifesaving shocks under optimal GDMT.
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Affiliation(s)
| | - Eike Groene
- Albertinen Cardiovascular Center, Hamburg, Germany
| | | | | | - Matthias P Nägele
- Department of Cardiology, University Hospital of Zürich, Rämistrasse, Switzerland
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4
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Garcia R, Combes N, Defaye P, Narayanan K, Guedon-Moreau L, Boveda S, Blangy H, Bouet J, Briand F, Chevalier P, Cottin Y, Da Costa A, Degand B, Deharo JC, Eschalier R, Extramiana F, Goralski M, Guy-Moyat B, Guyomar Y, Hermida JS, Jourda F, Lellouche N, Mahfoud M, Manenti V, Mansourati J, Martin A, Pasquié JL, Ritter P, Rollin A, Tibi T, Yalioua A, Gras D, Sadoul N, Piot O, Leclercq C, Marijon E. Wearable cardioverter-defibrillator in patients with a transient risk of sudden cardiac death: the WEARIT-France cohort study. Europace 2021; 23:73-81. [PMID: 33257972 PMCID: PMC7842091 DOI: 10.1093/europace/euaa268] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Aims We aimed to provide contemporary real-world data on wearable cardioverter-defibrillator (WCD) use, not only in terms of effectiveness and safety but also compliance and acceptability. Methods and results Across 88 French centres, the WEARIT-France study enrolled retrospectively patients who used the WCD between May 2014 and December 2016, and prospectively all patients equipped for WCD therapy between January 2017 and March 2018. All patients received systematic education session through a standardized programme across France at the time of initiation of WCD therapy and were systematically enrolled in the LifeVest Network remote services. Overall, 1157 patients were included (mean age 60 ± 12 years, 16% women; 46% prospectively): 82.1% with ischaemic cardiomyopathy, 10.3% after implantable cardioverter-defibrillator explant, and 7.6% before heart transplantation. Median WCD usage period was 62 (37–97) days. Median daily wear time of WCD was 23.4 (22.2–23.8) h. In multivariate analysis, younger age was associated with lower compliance [adjusted odds ratio (OR) 0.97, 95% confidence interval (CI) 0.95–0.99, P < 0.01]. A total of 18 participants (1.6%) received at least one appropriate shock, giving an incidence of appropriate therapy of 7.2 per 100 patient-years. Patient-response button allowed the shock to be aborted in 35.7% of well-tolerated sustained ventricular arrhythmias and in 95.4% of inappropriate ventricular arrhythmia detection, finally resulting in an inappropriate therapy in eight patients (0.7%). Conclusion Our real-life findings reinforce previous studies on the efficacy and safety of the WCD in the setting of transient high-risk group in selected patients. Moreover, they emphasize the fact that when prescribed appropriately, in concert with adequate patient education and dedicated follow-up using specific remote monitoring system, compliance with WCD is high and the device well-tolerated by the patient.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, 86021 Poitiers, France.,Univ Poitiers, 86000 Poitiers, France
| | - Nicolas Combes
- Department of Cardiology, Pasteur Clinic, 33000 Toulouse, France
| | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital, 38043 Grenoble, France
| | - Kumar Narayanan
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Medicover Hospitals, Hyderabad, India
| | | | - Serge Boveda
- Department of Cardiology, Pasteur Clinic, 33000 Toulouse, France
| | - Hugues Blangy
- Department of Cardiology, Nancy University Hospital, 54500 Vandoeuvre-Lès-Nancy, France
| | - Jérôme Bouet
- Department of Cardiology, Hospital Center of Aix, 13080 Aix En Provence, France
| | - Florent Briand
- Department of Cardiology, Besançon University Hospital, 25000 Besançon, France
| | | | - Yves Cottin
- Department of Cardiology, Dijon University Hospital, 28000 Dijon, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, 42000 Saint-Étienne, France
| | - Bruno Degand
- Department of Cardiology, Poitiers University Hospital, 86021 Poitiers, France
| | - Jean-Claude Deharo
- Department of Cardiology, University Hospital La Timone, 13000 Marseille, France
| | - Romain Eschalier
- Department of Cardiology Clermont-Ferrand University Hospital, 63000 Clermont Ferrand, France
| | - Fabrice Extramiana
- Department of Cardiology, Bichat Hospital - Claude Bernard, 75877 Paris, France
| | - Marc Goralski
- Department of Cardiology, General Hospital of Oréans, 45000 Orléans, France
| | - Benoit Guy-Moyat
- Department of Cardiology, Limoges University Hospital, 87000 Limoges, France
| | - Yves Guyomar
- Department of Cardiology, Hospital Center Saint Philibert, 59160 Lomme, France
| | | | - François Jourda
- Department of Cardiology, General Hospital of Auxerre, 89000 Auxerre, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital Henri Mondor, 94000 Creteil, France
| | - Mohanad Mahfoud
- Department of Cardiology, Hospital Center Sud Francilien, 91100 Corbeil Essonnes, France
| | - Vladimir Manenti
- Department of Cardiology, Jacques Cartier Institute, 91300 Massy, France
| | - Jacques Mansourati
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Angéline Martin
- Department of Cardiology, Fontaine Clinic, 21121 Fontaine-Lès-Dijon, France
| | - Jean-Luc Pasquié
- Department of Cardiology, Montpellier University Hospital, 34000 Montpellier, France
| | - Philippe Ritter
- Department of Cardiology, Bordeaux University Hospital, 33600 Pessac, France
| | - Anne Rollin
- Department of Cardiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Thierry Tibi
- Department of Cardiology, General Hospital of Cannes, 06150 Cannes, France
| | - Arab Yalioua
- Department of Cardiology, General Hospital of Angoulême, 16000 Angoulême, France
| | - Daniel Gras
- Department of Cardiology, Hopital privé du Confluent, 44000 Nantes, France
| | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, 54500 Vandoeuvre-Lès-Nancy, France
| | - Olivier Piot
- Department of Cardiology, Cardiology Center of Nord, 93200 Saint Denis, France
| | | | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France
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5
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Clementy N, Bensaid R, Bouteau J, Fedida J, Kiavue Y, Socie P, Ackermann R, Goralski M, Fauchier L, Bernard A, Angoulvant D, Babuty D. The IC-D score for predicting prophylactic cardioverter-defibrillator implantation following acute myocardial infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:973-979. [PMID: 33846979 DOI: 10.1111/pace.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A reduced left ventricular ejection fraction (LVEF) ≤35% ≥6 weeks following an acute myocardial infarction (MI) may indicate prophylactic implantation of a cardioverter-defibrillator (ICD). We sought to find predictors of absence of significant left ventricular (LV) remodeling post-MI. METHODS All consecutive patients hospitalized for acute MI with an LVEF ≤35% at discharge in our institution from 2010 were retrospectively included. Patients were assigned to two groups according to the persistence of an LVEF ≤35% (ICD+) or a recovery >35% (ICD-). Logistic regression was performed to build a predictive score, which was then externally validated. RESULTS Among a total of 1533 consecutive MI patients, 150 met inclusion criteria, 53 (35%) in the ICD+ group and 97 in the ICD group. After multivariable analyses, an LVEF ≤25% at discharge (adjusted OR 6.23 [2.47 to 17.0], p < .0001) and a CPK peak at the MI acute phase >4600 UI/L (adjusted OR 9.99 [4.27 to 25.3], p < .0001) both independently predicted non-recovery at 6 weeks. The IC-D (Increased Cpk-LV Dysfunction) score predicted persistent LVEF ≤35% with areas under curve of 0.83 and 0.73, in the study population and in a multicenter validation cohort of 150 patients, respectively (p < .0001). CONCLUSIONS The association of a severely reduced LVEF and a major release of myocardial necrosis biomarkers at the acute phase of MI predict unfavorable remodeling, and prophylactic ICD implantation.
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Affiliation(s)
- Nicolas Clementy
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Reda Bensaid
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Jérémie Bouteau
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Joël Fedida
- Cardiology Department, Bicêtre Hospital, Kremlin-Bicêtre, France
| | - Yoann Kiavue
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Pierre Socie
- Cardiology Department, Chartres Louis Pasteur Hospital, Le Coudray, France
| | - Romain Ackermann
- Cardiology Department, Orleans La Source Hospital, Orleans, France
| | - Marc Goralski
- Cardiology Department, Orleans La Source Hospital, Orleans, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Anne Bernard
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Denis Angoulvant
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Dominique Babuty
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
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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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Sandhu U, Rajyaguru C, Cheung CC, Morin DP, Lee BK. The wearable cardioverter-defibrillator vest: Indications and ongoing questions. Prog Cardiovasc Dis 2019; 62:256-264. [PMID: 31077726 DOI: 10.1016/j.pcad.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 12/28/2022]
Abstract
Multiple clinical trials have demonstrated the efficacy of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death (SCD) among specific high-risk populations. However, it remains unclear how to optimally treat those patients who are at elevated risk of cardiac arrest but are not among the presently identified groups proven to benefit from an ICD, are unable to tolerate surgical device implantation, or refuse invasive therapies. The wearable cardioverter-defibrillator (WCD) is an alternative antiarrhythmic device that provides continuous cardiac monitoring and defibrillation capabilities through a noninvasive, electrode-based system. The WCD has been shown to be highly effective at restoration of sinus rhythm in patients with a ventricular tachyarrhythmia, and one randomized trial using the WCD in patients with recent myocardial infarction at elevated risk for arrhythmic death reported a decrease in overall mortality despite no SCD mortality benefit. The current clinical indications for WCD use are varied and continue to evolve as experience with this technology increases.
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Affiliation(s)
- Uday Sandhu
- Division of Cardiology, University of California, San Francisco-Fresno Program
| | - Chirag Rajyaguru
- Division of Cardiology, University of California, San Francisco-Fresno Program
| | - Christopher C Cheung
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center and University of Queensland Ochsner Clinical School, New Orleans, LA
| | - Byron K Lee
- Division of Cardiology, Electrophysiology and Arrhythmia Service, University of California, San Francisco.
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8
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Gul EE, Haseeb S. Wearable cardioverter-defibrillator and ventricular arrhythmias: risk stratification in patients with shorter device use. Europace 2019; 21:525. [DOI: 10.1093/europace/euy283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
| | - Sohaib Haseeb
- Division of Cardiology, Kingston Health Sciences Center, Queen’s University, Kingston, Ontario, Canada
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9
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Kutyifa V. Wearable cardioverter-defibrillator and ventricular arrhythmias: risk stratification in patients with shorter device use-Authors' reply. Europace 2019; 21:525-526. [PMID: 30561623 DOI: 10.1093/europace/euy287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Valentina Kutyifa
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, Clinical Cardiovascular Research Center, 265 Crittenden Blvd., Rochester, NY, USA
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10
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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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12
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Stevenson WG, Hindricks G. Ventricular arrhythmias and sudden cardiac death: new research insights with clinical implications. Europace 2018. [DOI: 10.1093/europace/euy207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William G Stevenson
- Division of Cardiovascular Medicine, Arrhythmia Section, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
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Nielsen JC, Johansen JB. The time is not ripe for the wearable cardioverter-defibrillator. Europace 2018; 20:f146-f147. [PMID: 29905810 DOI: 10.1093/europace/euy135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jens Brock Johansen
- Department of Cardiology, Danish Pacemaker and ICD Registry, Odense University Hospital, Odense, Denmark
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