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Dang PL, Lacour P, Parwani AS, Baehr FL, Primessnig U, Schoeppenthau D, Dreger H, Dagres N, Hindricks G, Boldt LH, Blaschke F. False Alarms in Wearable Cardioverter Defibrillators-A Relevant Issue or an Insignificant Observation. J Clin Med 2024; 13:7768. [PMID: 39768691 PMCID: PMC11728023 DOI: 10.3390/jcm13247768] [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: 11/08/2024] [Revised: 12/15/2024] [Accepted: 12/17/2024] [Indexed: 01/16/2025] Open
Abstract
Background: The wearable cardioverter defibrillator (WCD) has emerged as a valuable tool used for temporary protection from sudden cardiac death. However, since the WCD uses surface electrodes to detect arrhythmias, it is susceptible to inappropriate detection. Although shock conversion rates for the WCD are reported to be high for detected events, its efficacy in clinical practice tends to be degraded by patient noncompliance. Reasons for this include wearer discomfort and frequent false alarms, which may interrupt sleep and generate anxiety. Up to now, data on the incidence of false alarms emitted by the WCD and their predictors are rare. Objectives: The aim of our study was to assess the relationship between both artifact sensing and episode misclassification burden and wearing compliance in patients with a WCD (ZOLL LifeVest™ 4000 system, ZOLL CMS GmbH, Cologne, Germany). Methods and Results: We conducted a single-center retrospective observational study, analyzing patients with a WCD prescribed at our institution. A total of 134 patients (mean age 51.7 ± 13.8 years, 79.1% male) were included. Arrhythmia recordings were analyzed and categorized as non-sustained ventricular tachycardia, sustained ventricular tachycardia or fibrillation, artifact sensing or misclassified episodes. Indication for WCD prescription was both primary and secondary prophylaxis. A total of 3019 false WCD alarms were documented in 78 patients (average number of false alarms 38.7 ± 169.5 episodes per patient) over a mean WCD wearing time of 71.5 ± 70.9 days (daily WCD wearing time 20.2 ± 5.0 h). In a total of 78 patients (58.2% of the study population), either artifact sensing (76.9%), misclassified episodes (6.4%), or both (16.7%) occurred. Misclassified episodes included sinus tachycardias, atrial flutter, atrial fibrillation, premature ventricular contractions (PVCs), and intermittent bundle branch block. A multiple linear regression identified loop diuretics (regression coefficient [B] -0.11; 95% CI -0.21-(-0.0001); p = 0.049), angiotensin receptor-neprilysin inhibitors (ARNIs) (B -0.11; 95% CI 0.22-(-0.01); p = 0.033), and a higher R-amplitude of the WCD baseline electrocardiogram (ECG) (B -0.17; 95% CI -0.27-(-0.07); p = 0.001) as independent predictors for a lower number of artifact episodes per day. In addition, atrial fibrillation (B 0.05; 95% CI 0.01-0.08; p = 0.010), and calcium antagonists (B 0.07; 95% CI 0.02-0.12; p = 0.012) were independent predictors for increased numbers of misclassified episodes per day, while beta-blockers seemed to reduce them (B -0.06; 95% CI -0.10-(-0.01); p = 0.013). Patients terminated 61.0% of all false alarms manually by pressing the response button on average 1.9 times per false alarm with overall 3.6 manual terminations per affected patient per month. Conclusions: In conclusion, false alarms from the ZOLL LifeVest™ system were frequent, with artifact sensing being the most common cause. Hence, the occurrence of false alarms represents a significant side effect of WCD therapy, and efforts should be made to minimize false alarms.
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Affiliation(s)
- Phi Long Dang
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
| | - Philipp Lacour
- Study Center Berlin, IB University of Health and Social Sciences, 12683 Berlin, Germany
| | - Abdul Shokor Parwani
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
| | - Felix Lucas Baehr
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
| | - Uwe Primessnig
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
| | - Doreen Schoeppenthau
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
| | - Nikolaos Dagres
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerhard Hindricks
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
| | - Florian Blaschke
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (P.L.D.); (A.S.P.); (D.S.); (H.D.); (L.-H.B.)
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany (G.H.)
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Kikuchi N, Shiga T, Sugawara Y, Suzuki A, Minami Y, Hattori H, Shoda M, Hagiwara N, Yamaguchi J. Clinical outcomes during and after wearable cardioverter defibrillator use in Japanese patients with heart failure: A single-center experience. J Arrhythm 2024; 40:1462-1472. [PMID: 39669941 PMCID: PMC11632265 DOI: 10.1002/joa3.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 12/14/2024] Open
Abstract
Background A wearable cardioverter defibrillator (WCD) is indicated for a limited period in patients at high risk of sudden cardiac death (SCD). Nonischemic heart failure (HF) is common among Japanese patients with HF. The aim of this study was to evaluate the incidence of fatal arrhythmias during WCD use and the clinical outcomes after WCD withdrawal in Japanese patients with HF. Methods We retrospectively studied 105 hospitalized HF patients who were discharged with a WCD. The main outcome was SCD/ventricular arrhythmias during WCD use and the other outcomes were implantation of an implantable cardioverter-defibrillator (ICD), SCD/ventricular arrhythmias after WCD withdrawal, and changes in left ventricular ejection fraction (LVEF). Results Eighty-seven (83%) patients received a WCD for primary prevention of SCD, of whom 60 (69%) were new-onset HF patients with an LVEF ≤35%. The median daily wear time was 22.1 h. Two patients experienced sustained ventricular tachycardia and one patient experienced atrioventricular block with asystole while on WCD. After WCD withdrawal, 81 (77%) patients decided not to receive ICD implantation. The percentage of patients with an LVEF ≥35% increased from 20% at baseline to 70% at 1 year after discharge. During the median follow-up of 50 months, 78 (96%) of the 81 patients who did not have an ICD were free of SCD/ventricular arrhythmias. Conclusions The use of a WCD is useful for determining the appropriate indication for ICD implantation in Japanese patients with new-onset HF, a low LVEF, and a risk of SCD.
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Affiliation(s)
- Noriko Kikuchi
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Tsuyoshi Shiga
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
- Department of Clinical Pharmacology and TherapeuticsThe Jikei University School of MedicineTokyoJapan
| | - Yohei Sugawara
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Atsushi Suzuki
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Yoshiaki Minami
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | | | - Morio Shoda
- Clinical Research Division for Heart Rhythm ManagementTokyo Women's Medical UniversityTokyoJapan
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Lenormand T, Bodin A, Fauchier L. The Role of the Wearable Defibrillator in Heart Failure. Curr Heart Fail Rep 2024; 21:33-42. [PMID: 38236485 DOI: 10.1007/s11897-023-00641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Wearable cardioverter defibrillators (WCDs) have been developed as a temporary measure for protecting patients at risk for sudden cardiac death that do not meet the indication for implantable cardioverter defibrillator (ICD), most notably in the early stages of heart failure with reduced ejection fraction before reassessment of their left ventricular ejection fraction. In this review, we report available evidence in the literature and guidelines regarding WCD use in order to try to define the role WCDs may have in heart failure. RECENT FINDINGS In the last decade, most observational studies found WCDs to be both safe and effective in terminating ventricular arrhythmias in various indications, mostly centered around heart failure with reduced ejection fraction. The only available randomized controlled trial using WCD did not however show a benefit on patients' survival. Hence, recent guidelines only recommended its use in limited indications. Recent data also suggest a possible interest of WCD in monitoring patients, a finding that may prove useful in the context of new-onset heart failure. Data regarding WCD benefit is scarce, and definitive conclusions on its utility are hard to draw. In the context of heart failure, and particularly new-onset heart failure, WCD might find a role in a global comprehensive management of the disease, both acting as an educational tool, a monitoring tool, and, most importantly, a safe and effective tool in preventing sudden cardiac death. The low level of evidence however invites caution, and the decision of prescribing a WCD needs to be individualized and thoroughly discussed with the patient whose compliance is key with this device.
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Affiliation(s)
- Thibault Lenormand
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine, Université François Rabelais, Tours, France.
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