The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients

Erath, Julia W.; Vámos, Máté; Sirat, Abdul Sami; Hohnloser, Stefan H.

doi:10.1007/s00392-016-1054-1

Cited by 33 publications

(38 citation statements)

References 21 publications

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“…ICD implantation rate in the whole patient cohort was 54%. This parallels other studies with similar patient collectives that reported implantation rates of 34 to 57% [ 9 , 14 , 16 , 21 , 22 ]. Naturally, ICD implantation rate was highest in the patient group with a prior explanted trans-venous ICD.…”

Section: Discussionsupporting

confidence: 90%

Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting

Röger

Rosenkaimer

Hohneck

et al. 2018

BMC Cardiovasc Disord

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BackgroundThe wearable cardioverter-defibrillator (WCD) has emerged as a valuable tool to temporarily protect patients at risk for sudden cardiac death (SCD). The aim of this study was to determine the value of the WCD for therapy optimization of heart failure patients.MethodsOne hundred five consecutive patients that received WCD between 4/2012 and 9/2016 were included in the study. All patients were followed for clinical outcome and echocardiographic parameters during WCD therapy and had continued follow-up after WCD therapy, irrespective of subsequent implantable cardioverter-defibrillator (ICD) implantation.ResultsThe most common indication for WCD were newly diagnosed ischemic (ICM) or non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction (LVEF) ≤35%. Mean WCD wear time was 68.8 ± 50.4 days with a mean daily use of 21.5 ± 3.5 h. Five patients (4.8%) received a total of five appropriate WCD shocks.During WCD wear, patients with ICM and NICM showed significant improvement in LVEF, reducing the proportion of patients with a need for primary preventive ICD implantation to 54.8% (ICM) and 48.8% (NICM). An ICD was finally implanted in 51.4% of the study patients (24 trans-venous ICDs, 30 subcutaneous ICDs).After discontinuation of WCD therapy, all patients were followed for a mean of 18.6 ± 12.3 months. 5.6% of patients with implanted ICDs received appropriate therapies. No patient with subcutaneous ICD needed change to a trans-venous device. None of the patients without an implanted ICD suffered from ventricular tachyarrhythmias and no patient died suddenly.In patients with NICM a significant LVEF improvement was observed during long-term follow-up (from 34.8 ± 11.1% to 41.0 ± 10.2%).ConclusionsWCD therapy successfully bridged all patients to either LVEF recovery or ICD implantation. Following WCD, ICD implantation could be avoided in almost half of the patients. In selected patients, prolongation of WCD therapy beyond 3 months might further prevent unnecessary ICD implantation. The WCD as an external monitoring system contributed important information to optimize device selection in patients that needed ICD implantation.

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Section: Discussionsupporting

confidence: 90%

Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting

Röger

Rosenkaimer

Hohneck

et al. 2018

BMC Cardiovasc Disord

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“…Our data shows that patients with PPCM are facing a relevant risk for life-threatening arrhythmias in the first months after diagnosis. The WCD has shown to be effective in preventing sudden cardiac death in several other cardiomyopathies [12], especially post myocardial infarction and in non-ischemic cardiomyopathy [13–15]. In the special setting of ICD removal due to infection, a WCD-guided strategy has been shown to be cost-effective [16].…”

Section: Discussionmentioning

confidence: 99%

Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis

et al. 2017

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IntroductionPeripartum cardiomyopathy (PPCM) is a rare cardiomyopathy characterized by an acute reduction in left ventricular ejection fraction (LVEF). Sudden deaths during the course of PPCM are reported to be elevated, the underlying mechanisms remains unknown. The aim of the present multi-centre study was to evaluate the arrhythmia burden in a multi-centre approach in patients with PPCM using a wearable cardioverter/defibrillator (WCD).Methods and resultsForty-nine patients from 16 German centres with newly diagnosed PPCM and LVEF ≤35% receiving a WCD were included in this retrospective analysis. Mean follow-up was 15 ± 10 months. At diagnosis, mean age was 33 ± 5 years, parity was 2.1 ± 1.6, LVEF was 21 ± 7%, NYHA functional class was 3.4 ± 0.7. Mean wear time was 120 ± 106 days, mean wear time per day was 21.4 ± 3.3 h. Six (12%) patients presented eight ventricular tachyarrhythmias during WCD period: five episodes of VF, two sustained ventricular tachycardia (VT) and one non-sustained VT occurred.ConclusionThis multicentre study underpins the elevated risk for ventricular tachyarrhythmias in patients with newly diagnosed PPCM and reduced LVEF. A WCD should be considered for 3–6 months in these patients to prevent sudden cardiac death from ventricular tachyarrhythmias.

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“…None of these studies use implanted recorder to detect the arrhythmia recurrence which makes their estimation of AF recurrent rate suboptimal. For expense or non-invasive reason, wearable instrument which was usually used to avoid unnecessary ICD implantation might take as the substitution [ 54 ]. Testing studies on these scores with much precise recurrent AF rate may help to improve overcome this limitation.…”

Section: Introductionmentioning

confidence: 99%

Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review

et al. 2017

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Patients with atrial fibrillation (AF) are commonly managed with rhythm control strategy, but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF, and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation. Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF. The more common factors have been used to formulate risk stratification scores, to help predict the outcomes of rhythm control treatments or AF progression. This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression.

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The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients

Abstract: WCD therapy was well accepted by patients and provided temporary protection against ventricular tachyarrhythmias in patients at risk for SCD. The WCD may help to avoid unnecessary ICD implantations in a significant proportion of patients.

Cited by 33 publications

References 21 publications

Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting

Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting

Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis

Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review

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