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Wearable cardioverter-defibrillator as a bridge to cardiac transplantation: A national database analysis
Madalina Opreanu1, Chingping Wan2, Vini Singh1
1Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan.
Insights
The wearable cardioverter-defibrillator (WCD) is a safe and effective bridge therapy for patients awaiting heart transplantation (HT), significantly reducing the risk of sudden cardiac death (SCD). This study highlights high compliance and efficacy with low complication rates in this high-risk population.
Area of Science:
- Cardiology
- Medical Devices
- Transplantation Medicine
Background:
- Life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD) pose significant risks for patients awaiting heart transplantation (HT).
- Implantable cardioverter-defibrillators (ICDs) are used for primary prevention but carry risks and contraindications in this population.
- Wearable cardioverter-defibrillators (WCDs) offer a potential alternative bridging therapy during the pre-transplant period.
Purpose of the Study:
- To evaluate the efficacy and safety of WCDs as a bridge therapy for patients awaiting HT.
- To assess patient compliance and complication rates associated with WCD use in this cohort.
Main Methods:
- A convenience sample of 121 patients prescribed WCDs as bridge therapy to HT was retrospectively analyzed.
- Data collected included demographics, transplantation status, comorbidities, device usage, and reasons for discontinuation.
- Statistical analyses were performed using SPSS version 17 and GraphPad PRISM 5.
Main Results:
- The study included 121 patients (69% male, mean age 44 ± 18 years) with a mean ejection fraction of 25 ± 15%.
- The majority had non-ischemic cardiomyopathy (55%) and were in NYHA Class III/IV heart failure (66%).
- Patients wore the WCD for a median of 39 days (average 17 hours/day); 6% received appropriate shocks, with 9% mortality and low complication rates.
Conclusions:
- A significant proportion of patients on the HT waiting list experience ventricular arrhythmias.
- WCD use demonstrated high compliance, efficacy, and a low complication rate in this study.
- The WCD is a viable bridging therapy for preventing sudden cardiac death in patients awaiting heart transplantation.
Background:
Life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD) are common in patients awaiting heart transplantation (HT), and the implantable cardioverter-defibrillator (ICD) is often used for primary prevention in this setting. Use of ICDs in these patients is not without risks and is sometimes contraindicated. The wearable cardioverter-defibrillator (WCD) may be a reasonable alternative to bridge the period of risk leading up to HT.
Methods:
We obtained a convenience sample of patients prescribed an WCD as a bridge therapy to HT. The available data consisted of demographics, cardiac transplantation status, associated comorbidities, device use, device-stored electrocardiogram (ECG) and reason for discontinuing the WCD. Statistical analyses were performed using SPSS version 17 and GraphPad PRISM 5.
Results:
The registry included 121 patients consisting of 83 (69%) men and 38 (31%) women. The mean age was 44 ± 18 years. Mean ejection fraction was 25 ± 15%. Non-ischemic cardiomyopathy (CMP) was the underlying diagnosis in 67 (55%) patients, whereas 21 (17%) patients had ischemic CMP and 33 (27%) had a mixed or uncharacterized CMP. New York Heart Association Class III heart failure was present in 32% and 34% were in Class IV. Eighty-eight patients (73%) were being evaluated for HT or were on an HT waiting list, and 33 patients (27%) had had a prior HT, experienced rejection, and were awaiting re-transplantation. The patients wore the WCD for an average of 127 ± 392 days (median 39 days) with average daily use of 17 ± 7 hours (median 20 hours). Seven patients (6%) received appropriate WCD shocks. Fifty-one patients (42%) ended use after ICD implantation and 13 patients (11%) after HT. There were 11 deaths (9%).
Conclusions:
A significant proportion of patients on the HT waiting list will have VA. WCD use in our study showed high compliance and efficacy and a low complication rate, suggesting that the WCD is a reasonable bridge therapy for preventing SCD in patients awaiting HT.
