Der tragbare Kardioverter/Defibrillator (WCD) – Indikationen und Einsatz

Deneke, Thomas; Bosch, Ralph; Eckardt, Lars; Nowak, Bernd; Schwab, Joerg O.; Sommer, Philipp; Veltmann, Christian; Helms, Thomas M.

doi:10.1007/s12181-019-0331-4

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…As there are no equivalent recommendations for the use of a WCD, national societies have published advisories to overcome the lack of specific contraindications in the guidelines: the American Heart Association (AHA) advices not to use a WCD in patients with a high risk of a nonarrhythmic fatal event that significantly exceeds the risk of an arrhythmic death, with an expected survival of less than 6 months (Class III recommendation, LoE C) [ 33 ]. The German Society of Cardiology specifies contraindications in a position paper for WCD use [ 34 ]: patients refusing an ICD implantation as well as patients not capable of handling a WCD or permanently not being eligible for an ICD candidacy according to the current guidelines (2,10) may likewise not be eligible for WCD prescription.…”

Section: The Wearable Cardioverter Defibrillator (Wcd)mentioning

confidence: 99%

“…The position paper for WCD use from the German Society of Cardiology recommends not only intense patient education but also active surveillance of the actual wearing compliance. If the compliance is constantly lower than 20 h/day and does not improve even after a follow-up training, the ongoing use of a WCD is contraindicated [ 34 ].…”

Section: Multiparameter Monitoringmentioning

confidence: 99%

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Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

Rohrer

Manninger

Zirlik

et al. 2021

Sensors

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A wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and for patients who are temporarily not candidates for an implantable cardioverter defibrillator (ICD). In addition, the need for telemedical concepts in the detection and treatment of heart failure (HF) and its arrhythmias is growing. The WCD has evolved from a shock device detecting malignant ventricular arrhythmias (VA) and treating them with shocks to a heart-failure-monitoring device that captures physical activity and cardioacoustic biomarkers as surrogate parameters for HF to help the treating physician surveil and guide the HF therapy of each individual patient. In addition to its important role in preventing SCD, the WCD could become an important tool in heart failure treatment by helping prevent HF events by detecting imminent decompensation via remote monitoring and monitoring therapy success.

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Section: The Wearable Cardioverter Defibrillator (Wcd)mentioning

confidence: 99%

Section: Multiparameter Monitoringmentioning

confidence: 99%

Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

Rohrer

Manninger

Zirlik

et al. 2021

Sensors

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“…Patients with heart failure with reduced ejection fraction (HFrEF) secondary to ischemic or non-ischemic cardiomyopathy may be at high risk for malignant arrhythmias and sudden cardiac death [ 1 , 2 , 3 ] without meeting implantable cardioverter–defibrillator (ICD) implantation criteria [ 4 ]. The wearable cardioverter–defibrillator (WCD) can be used in such patients during HFrEF therapy optimization and ongoing risk stratification [ 2 , 3 , 4 , 5 , 6 ]. Previous studies have analyzed the effectiveness of the WCD regarding different indications in patients with ischemic and non-ischemic cardiomyopathy [ 1 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and First Results of Heart Failure Monitoring Using the Wearable Cardioverter–Defibrillator in Newly Diagnosed Heart Failure with Reduced Ejection Fraction

Hillmann

Hohmann

Mueller-Leisse

et al. 2021

Sensors

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The wearable cardioverter–defibrillator (WCD) is used in patients with newly diagnosed heart failure and reduced ejection fraction (HFrEF). In addition to arrhythmic events, the WCD provides near-continuous telemetric heart failure monitoring. The purpose of this study was to evaluate the clinical relevance of additionally recorded parameters, such as heart rate or step count. We included patients with newly diagnosed HFrEF prescribed with a WCD. Via the WCD, step count and heart rate were acquired, and an approximate for heart rate variability (HRV5) was calculated. Multivariate analysis was performed to analyze predictors for an improvement in left ventricular ejection fraction (LVEF). Two hundred and seventy-six patients (31.9% female) were included. Mean LVEF was 25.3 ± 8.5%. Between the first and last seven days of usage, median heart rate fell significantly (p < 0.001), while median step count and HRV5 significantly increased (p < 0.001). In a multivariate analysis, a delta of HRV5 > 23 ms was an independent predictor for LVEF improvement of ≥10% between prescription and 3-month follow-up. Patients with newly diagnosed HFrEF showed significant changes in heart rate, step count, and HRV5 between the beginning and end of WCD prescription time. HRV5 was an independent predictor for LVEF improvement and could serve as an early indicator of treatment response.

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“…Nach den Ergebnissen der VEST-Studie geht eine Therapie mit der LifeVest bei Patienten mit eingeschränkter linksventrikulärer Pumpfunktion in der frühen Postinfarktphase nicht mit einer signifikanten Reduktion des arrhythmogenen Todes einher und sollte somit nicht routinemäßig in diesem Patientenkollektiv zur Anwendung kommen. Die Entscheidung sollte im Einzelfall nach individueller Risikostratifikation eines jeweiligen Patienten getroffen werden [17]. Leitlinien ersetzen grundsätzlich nicht die ärztliche Evaluation des individuellen Patienten und die Anpassung der Therapie an dessen spezifische Situation.…”

Section: Introductionunclassified

Wenn die Weste einige Nummern zu groß ist: Sinn und Unsinn der LifeVest bei Postinfarktpatienten

Bonnemeier

2020

Aktuelle Kardiologie

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ZusammenfassungDie LifeVest ist eine tragbare Kardioverter-Defibrillator-Weste (WCD), die eine zeitlich limitierte diagnostische und therapeutische, nicht invasive Option für Patienten mit einem hohen Risiko für den plötzlichen Herztod (PHT) auf dem Boden von lebensbedrohlichen anhaltenden ventrikulären Tachyarrhythmien darstellt. Hierbei hat sich die LifeVest sowohl bei Patienten mit transienter höhergradiger linksventrikulärer Dysfunktion als auch bei Patienten zur Überbrückung bis zur endgültigen Versorgung mit einem implantierbaren Kardioverter-Defibrillator (ICD) in der klinischen Praxis etabliert. Unklar waren bislang die Effektivität und der zusätzliche Benefit der WCD innerhalb der ersten Wochen nach stattgehabtem Myokardinfarkt bei Patienten mit reduzierter linksventrikulärer Pumpfunktion. In der prospektiven, randomisierten und kontrollierten VEST-Studie konnte kein Zusatznutzen der WCD bezüglich der Verhinderung des PHT in dieser Patientengruppe aufgezeigt werden.

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Der tragbare Kardioverter/Defibrillator (WCD) – Indikationen und Einsatz

Cited by 15 publications

References 38 publications

Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

Feasibility and First Results of Heart Failure Monitoring Using the Wearable Cardioverter–Defibrillator in Newly Diagnosed Heart Failure with Reduced Ejection Fraction

Wenn die Weste einige Nummern zu groß ist: Sinn und Unsinn der LifeVest bei Postinfarktpatienten

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