Extended Use of the Wearable Cardioverter-Defibrillator: Which Patients Are Most Likely to Benefit?

Abstract

Background Wearable cardioverter-defibrillators (WCD, LifeVest, ZOLL) can protect from sudden cardiac death bridging a vulnerable period until a decision on implantable cardioverter-defibrillator (ICD) implantation can be reached. WCD is commonly used for 3 months or less. It is unknown, which patients use WCD longer and which patients are most likely to benefit from it. Hypothesis Extended use of WCD is reasonable in selected cases based on underlying heart disease and overall patient risk profile. Methods We conducted a systematic and comprehensive research of all published clinical studies on PubMed reporting on the use of the WCD. Only original articles reporting on wear times and time to appropriate shocks were included in our analysis. Results The search resulted in 127 publications. 14 parameters were reported necessary for inclusion in our analysis. Median wear times ranged from 16 to 394 days. The median wear time was especially long for patients suffering from nonischemic cardiomyopathy (NICM) (range: 50–71 days) and specifically peripartum cardiomyopathy (PPCM) (120 days) and for heart transplant candidates. There was a large variation of appropriate shocks according to indication for WCD use. In contrast to NICM in general, the number of appropriate shocks was particularly high in patients with PPCM (0 in 254 patients and 5 in 49 patients, respectively). The median and maximal time periods to the first appropriate shock were longest in patients with PPCM (median time to the first appropriate shock: 68 days). Conclusions Prolonged use of WCD is not uncommon in available literature. Patients suffering from NICM and specifically PPCM seem most likely to have longer therapy duration with WCD with success. Careful patient selection for prolonged use may decrease the need for ICD implantation in the future; however, prospective data are needed to confirm this hypothesis.

Outcomes during and after the use of the wearable cardioverter-defibrillator in a tertiary-care and a regional hospital in Switzerland

“…This is in line with previous findings [8,9,12,13] and may indicate a subgroup of patients who have a higher adherence to prescribed therapy. These patients may actually benefit from prolonged bridging with the goal of up-titration of optimal medical therapy to obviate the need for ICD implantation [14][15][16][17].…”

An Electrical Storm Is Coming!

“…Although the data cannot be analyzed for real-time viewing, it can be assessed after the acute event to identify trends or arrhythmia post event (Zoll Medical, 2021). The LifeVest is often a bridge to an ICD that is delayed because patients do not meet the immediate ICD implantation guidelines (Kovacs, Reek, Krasniqi, Eriksson, & Duru, 2018). The wearable converter-defibrillator was designed to reduce mortality in patients with both ischemic and nonischemic cardiomyopathy, with a reduced mortality rate at 6 weeks in patients with ischemic cardiomyopathy and an EF of 35% or less after an ischemic event.…”

Use of the wearable cardioverter-defibrillator – the Swiss experience

“…Kutyifa et al reported two patients out of 981 (0.2%) patients wearing the WCD >90 days receiving a treatment compared with 19 out of 1019 patients wearing the WCD ≤90 days [32]. Extended wear duration is commonly reported, but the treatment rate beyond 90 days of wear duration is very low [33]. These findings suggest that WCD wear duration may be further shortened without substantially compromising outcome.…”