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Published on: February 28, 2012
The Wearable Cardioverter-Defibrillator: Experience in 153 Patients and a Long-Term Follow-Up
Stephanie L Rosenkaimer1, Ibrahim El-Battrawy1,2, Tobias C Dreher1,2
1First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, 68167 Mannheim, Germany.
Insights
The wearable cardioverter-defibrillator (WCD) allowed 58% of high-risk patients to avoid implantable cardioverter-defibrillator (ICD) implantation. Long-term survival was good, with most patients avoiding shocks and demonstrating the need for better risk stratification.
Area of Science:
- Cardiology
- Medical Devices
- Sudden Cardiac Death Prevention
Background:
- Wearable cardioverter-defibrillators (WCD) serve as an alternative for patients at high risk of sudden cardiac death (SCD) when immediate implantable cardioverter-defibrillator (ICD) implantation is not feasible.
- Patient selection for WCDs, particularly in primary prevention, remains a challenge, with limited long-term data available.
Purpose of the Study:
- To evaluate the long-term outcomes of patients prescribed a WCD.
- To analyze the rate of subsequent implantable cardioverter-defibrillator (ICD) implantation and associated mortality in patients using a WCD.
- To assess the effectiveness and safety of WCDs in managing patients at risk for sudden cardiac death.
Main Methods:
- A retrospective study included 153 patients prescribed a WCD between April 2012 and March 2019.
- Follow-up data, including all-cause mortality and ICD implantation rates, were collected over a mean period of 36.2 months.
- Outcomes were analyzed based on disease etiology and subsequent ICD implantation.
Main Results:
- 58% of patients successfully avoided the need for ICD implantation after WCD use.
- The overall long-term survival rate was good, with 10% all-cause mortality.
- Patients with ischemic cardiomyopathy showed a trend towards higher mortality and received more ICD shocks compared to those with non-ischemic cardiomyopathy (p=0.04).
Conclusions:
- WCD use can obviate the need for ICD implantation in a significant proportion of patients, with favorable long-term survival.
- The majority of patients using WCDs did not experience shocks, and subsequent ICD implantation was avoided in many cases.
- Further research is needed to refine patient selection criteria and improve risk stratification for long-term ventricular tachyarrhythmia risk.
Abstract:
Background: The wearable cardioverter-defibrillator (WCD) is available for patients at high risk for sudden cardiac death (SCD) when immediate implantable cardioverter-defibrillator (ICD) implantation is not possible or indicated. Patient selection remains challenging especially in primary prevention. Long-term data on these patients is still lacking.
Methods:
153 patients were included in this study. They were prescribed the WCD between April 2012 and March 2019 at the University Medical Center, Mannheim, Germany. The mean follow-up period was 36.2 ± 15.6 months. Outcome data, including all-cause mortality, were analyzed by disease etiology and ICD implantation following WCD use.
Results:
We analyzed 56 patients with ischemic cardiomyopathy, 70 patients with non-ischemic cardiomyopathy, 16 patients with prior need for ICD/CRT-D (device for cardiac resynchronization therapy with defibrillator) explanation, 8 patients with acute myocarditis and 3 patients with congenital diseases. 58% of the patients did not need ICD/CRT-D implantation after WCD use. 4% of all patients suffered from appropriate WCD shocks. 2 of these patients (33%) experienced appropriate ICD shocks after implantation due to ventricular tachyarrhythmias. Long-term follow-up shows a good overall survival. All-cause mortality was 10%. There was no significant difference between patients with or without subsequent ICD implantation (p = 0.48). Patients with ischemic cardiomyopathy numerically showed a higher long-term mortality than patients with non-ischemic cardiomyopathy (14% vs. 6%, p = 0.13) and received significantly more ICD shocks after implantation (10% of ischemic cardiomyopathy (ICM) patients versus 3% of non-ischemic cardiomyopathy (NICM) patients, p = 0.04). All patients with ventricular tachyarrhythmias during WCD use or after ICD implantation survived the follow-up period.
Conclusion:
Following WCD use, ICD implantation could be avoided in 58% of patients. Long-term follow-up shows good overall survival. The majority of all patients did not suffer from WCD shocks nor did receive ICD shocks after subsequent implantation. Patient selection regarding predictive conditions on long-term risk of ventricular tachyarrhythmias needs further risk stratification.
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