Der tragbare Kardioverter-Defibrillator

Abstract

While the implantable cardioverter-defibrillator (ICD) has been proven to be the best choice for patients with long-term risk for sudden cardiac arrest/sudden cardiac death (SCA/SCD), the question is how to manage patients with only temporary risk, e.g., during the guidelines-recommended waiting period until the decision for an ICD can be made. These patient groups should be monitored around the clock to guarantee a lifesaving shock within a few minutes, if necessary.These conditions can be accomplished by the wearable cardioverter-defibrillator (WCD) in the outpatient sector. The WCD is worn on the skin and consists of four nonadhesive ECG electrodes as well as three defibrillation electrodes-two at the back and one at the front-embedded in a garment. The defibrillation unit is connected via a cord and can be worn over the shoulder or on a belt. Cardiac events can be recorded and retrospectively analyzed by the treating physician.The WCD is a safe and effective measure to terminate potentially lethal ventricular tachycardia and ventricular fibrillation. It may be used early after myocardial infarction with reduced left ventricular ejection fraction (LVEF), as well as for patients with acute heart failure in nonischemic cardiomyopathy with uncertain cause and prognosis. In addition, it may be used for patients waiting for heart transplantation, for patients who cannot be implanted an ICD due to comorbidities, and for patients after explantation of their ICD, e.g., because of infection until reimplantation.One may expect that risk stratification of patients with the WCD will lead to even better selection for ICD use.

Wearable Cardioverter-Defibrillator Used as a Telemonitoring System in a Real-Life Heart Failure Unit Setting

“…In patients who do not meet the criteria for primary ICD implantation, but who are at risk of SCD, e.g., due to transient reduced LVEF, the use of wearable cardioverter defibrillators (WCD) is recommended for the period between the acute event or initial diagnosis and the reevaluation after a sufficient time of optimal medical therapy, when the recovery of LVEF is expected or possible [4]. Furthermore, WCD is recommended as a bridge to implantation in patients with existing ICD indications who cannot receive the device or where an existing device has to be extracted due to temporary disorders, such as local or systemic infections [5][6][7][8]. Many studies suggest that using a WCD significantly reduces all-cause mortality in patients at high risk of SCD [9][10][11][12].…”