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Published on: February 28, 2012
Single-center experience with wearable cardioverter-defibrillator as a bridge before definitive ICD implantation
Giacomo Mugnai1, Antonio Lupo1, Francesca Zerbo1
1Cardiac Pacing and Electrophysiology, Cardiology Department, Public Hospital of Mirano, Mirano, VE, Italy.
Insights
The wearable cardioverter-defibrillator (WCD) helps patients with low ejection fraction avoid sudden cardiac death. Many patients using the WCD showed improved heart function, reducing the need for an implantable cardioverter-defibrillator (ICD).
Area of Science:
- Cardiology
- Medical Devices
Background:
- Wearable cardioverter-defibrillators (WCD) are approved for patients at risk of sudden arrhythmic death due to low left ventricular ejection fraction (LVEF).
- These patients are temporary candidates for WCDs when definitive implantable cardioverter-defibrillators (ICDs) are not suitable.
Purpose of the Study:
- To retrospectively analyze the single-center experience with WCD use.
- To evaluate the effectiveness of WCDs in patients with reduced LVEF.
Main Methods:
- Retrospective analysis of consecutive WCD applications between April 2017 and September 2018.
- Inclusion of 16 patients (mean age 57.7 years, 75% male) with mean LVEF of 32% at diagnosis.
- Exercise tests were performed to validate device arrhythmia detection.
Main Results:
- Mean LVEF improved to 42% at last follow-up (mean 3.1 months).
- At the end of the WCD period, 69% of patients (11/16) did not require ICD implantation.
- No appropriate or inappropriate shocks occurred during the follow-up period.
Conclusions:
- The WCD is a valuable tool for managing temporary increased risk of sudden cardiac death.
- A significant proportion of patients demonstrated improved LVEF, avoiding the need for ICD implantation.
Background:
The wearable cardioverter-defibrillator (WCD) has been approved for patients with poor left ventricular ejection fraction (LVEF) who are at risk of sudden arrhythmic death for a limited period but are not candidates for a definitive implantable cardioverter-defibrillator (ICD). The present study sought to retrospectively analyse our single-centre experience.
Methods And Results:
All consecutive WCDs applied between April 2017 and September 2018 in our centre were enrolled. An exercise test was performed in all patients in order to evaluate the absence of false detection of ventricular arrhythmias by the device. A total of 16 patients (57.7 ± 14.8 years old; 75% males) were taken into consideration for the analysis. Mean LVEF was 32 ± 11% at diagnosis and 42 ± 10% at last follow-up (mean, 3.1 ± 1.7 months; median, 3 months). At the end of the "wearing period" 11/16 patients (69%) did not have ICD implant indications and only 5 (31%) underwent ICD implantation. Neither appropriate nor appropriate shocks occurred during the follow up.
Conclusions:
The WCD represents a useful tool to bridge a temporarily increased risk for sudden cardiac death. The proportion of patients with an improvement of LVEF> 35% beyond the WCD-application period was considerable.
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