Potential roles of the wearable cardioverter-defibrillator in acute phase care of patients at high risk of sudden cardiac death: A single-center Japanese experience

Sasaki, Satoshi; Yamanaka, Shōji; Ishida, Yoshiteru; Kinjo, Takahiko; Tsushima, Yuichi; Seno, Maiko; Nishizaki, Fumie; Itoh, Taihei; Izumiyama, Kei; Yokota, Takashi; Yokoyama, Hiroaki; Yamada, Masahiro; Horiuchi, Daisuke; Kimura, Masaomi; Higuma, Takumi; Tomita, Hirofumi; Okumura, Ken

doi:10.1016/j.jjcc.2016.08.004

Cited by 11 publications

(17 citation statements)

References 15 publications

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“…Therefore, high-risk MI patients with SCD, such as those with a low left ventricular ejection fraction (LVEF) of ≤ 35%, should be monitored for at least 1 month after the onset of the MI according to the guidelines of the Japan Circulation Society [ 63 ]. If the patients have a transient high risk of lethal arrhythmias, a wearable ICD is recently indicated [ 64 ]. It can be expected to play a role as a bridge therapy to an ICD implantation and help the LV function recovery in patients at high risk for lethal VTAs, particularly during the acute phase of an MI and after a percutaneous coronary intervention (PCI).…”

Section: Risk Stratification Of Sudden Cardiac Death and Prevention Tmentioning

confidence: 99%

How to manage various arrhythmias and sudden cardiac death in the cardiovascular intensive care

Kobayashi

2018

j intensive care

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In the clinical practice of cardiovascular critical care, we often observe a variety of arrhythmias in the patients either with (secondary) or without (idiopathic) underlying heart diseases. In this manuscript, the clinical background and management of various arrhythmias treated in the CCU/ICU will be reviewed.The mechanism and background of lethal ventricular tachyarrhythmias vary as time elapses after the onset of MI that should be carefully considered to select a most suitable therapy. In the category of non-ischemic cardiomyopathy, several diseases are known to be complicated by the various ventricular tachyarrhythmias with some specific mechanisms.According to the large-scale registry data, the most common arrhythmia is atrioventricular block. It is essential for the decision of permanent pacemaker indication to rule out the presence of transient causes such as ischemia and electrolyte abnormalities.The prevalence of atrial fibrillation (AF) is very high in the patients with heart failure (HF) and myocardial infarction (MI). AF and HF have a reciprocal causal relationship; thus, both are associated with the poor prognosis. Paroxysmal AF occurs in 5 to 20% during the acute phase of MI and triggered by several specific factors including pump failure, atrial ischemia, and autonomic instability.After the total management of patients with various arrhythmias and basic heart diseases, the risk of sudden cardiac death should be stratified for each patient to assess the individual need for preventive therapies.Finally, it is recommended that the modalities of the treatment and prophylaxis should be selected on a case-by-case basis in the scene of critical care.

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Section: Risk Stratification Of Sudden Cardiac Death and Prevention Tmentioning

confidence: 99%

How to manage various arrhythmias and sudden cardiac death in the cardiovascular intensive care

Kobayashi

2018

j intensive care

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“…After addition of two citations identified by hand search, forty-six primary studies, two systematic reviews, and one HTA were included for final analysis (see Figure 1). The forty-six primary studies included one RCT 7, one nrCT (11), sixteen non-comparative prospective trials (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and twenty-eight non-comparative retrospective trials (4;28-54). The RCT showed a low and the nrCT a high risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness, efficacy, and safety of wearable cardioverter-defibrillators in the treatment of sudden cardiac arrest – Results from a health technology assessment

Aidelsburger¹,

Seyed-Ghaemi²,

Guinin³

et al. 2020

Int J Technol Assess Health Care

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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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“…12 studies were retrospective based on registries, and data were collected by the manufacturer of the WCD device [13–24]. One study was a prospective observational investigation [25], and one study prescribed the WCD according to a prespecified algorithm and prospectively followed the study population [26]. Of the retrospective studies, one was labelled a review [24], but also reported on WCD experiences in Germany and fulfilled inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

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

Kovacs

Reek

Krasniqi

et al. 2018

Cardiology Research and Practice

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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.

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Potential roles of the wearable cardioverter-defibrillator in acute phase care of patients at high risk of sudden cardiac death: A single-center Japanese experience

Abstract: The WCD use for the acute phase care of patients at high risk of VA can be safe and effective, and may be useful for evaluating indication of ICD implantation.

Cited by 11 publications

References 15 publications

How to manage various arrhythmias and sudden cardiac death in the cardiovascular intensive care

How to manage various arrhythmias and sudden cardiac death in the cardiovascular intensive care

Effectiveness, efficacy, and safety of wearable cardioverter-defibrillators in the treatment of sudden cardiac arrest – Results from a health technology assessment

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

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