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Published on: February 28, 2012
Wearable Cardioverter Defibrillator - Initial Experience in the Outpatient Setting in Japan
Ai Horiguchi1, Jun Kishihara1, Shinichi Niwano1
1Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan.
Insights
The wearable cardioverter defibrillator (WCD) shows good patient compliance in outpatient settings for preventing ventricular tachyarrhythmia (VTA). This wearable device is a viable option for high-risk patients needing VTA prevention.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- The wearable cardioverter defibrillator (WCD) is approved in Japan since 2014.
- Its efficacy in acute, in-hospital settings for ventricular tachyarrhythmia (VTA) is known.
- Clinical application in outpatient settings, particularly in Japan, requires further investigation.
Purpose of the Study:
- To evaluate the clinical use and patient compliance of WCD in an outpatient setting in Japan.
- To assess the effectiveness of WCD for primary and secondary prevention of VTA in ambulatory patients.
- To determine the role of WCD in managing patients at high risk for VTA.
Main Methods:
- A retrospective study of 43 consecutive patients using WCD in an outpatient setting (April 2014 - October 2019).
- Monitoring of event alerts and wearing compliance via a remote system.
- Assessment of WCD prescription reasons, shock events, and subsequent implantable cardioverter-defibrillator (ICD) decisions.
Main Results:
- High wearing compliance was observed, with a median daily wearing time of 23.1 hours.
- WCD was used for primary (16%) and secondary (84%) VTA prevention.
- Two appropriate and one inappropriate shocks occurred; 32 patients proceeded to ICD implantation.
Conclusions:
- Wearable cardioverter defibrillator (WCD) demonstrates excellent wearing compliance in the outpatient setting.
- WCD serves as a valuable tool for managing patients at high risk of ventricular tachyarrhythmia (VTA).
- Real-world data supports the utility of WCD for ambulatory VTA risk management.
Abstract:
The wearable cardioverter defibrillator (WCD) has been available since 2014 in Japan, and its benefit in the in-hospital acute phase at high risk of ventricular tachyarrhythmia (VTA) has been established, but its clinical use in the outpatient setting remains unclear, especially in Japan. The subjects consisted of 43 consecutive patients with WCD use in the outpatient setting from April 2014 to October 2019 at the present institute. Event alerts and wearing compliance were checked via the remote monitoring system, and a dedicated WCD training team contacted the patients if necessary. The median observation period was 51 days (IQR, 37-68 days) and the median daily wearing time was 23.1 h/day (IQR, 22.0-23.6 h/day). WCD was prescribed for primary prevention of VTA in 7 patients (16%), and for secondary prevention in 36 (84%). The common reason for WCD use was preventive therapy and/or clinical observation. Two appropriate and one inappropriate shock were observed. Eleven patients were not indicated for ICD because of successful catheter ablation optimal medical therapy, VTA in early onset of heart disease and refusal. The remaining 32 patients, however, underwent ICD implantation. In the present real-world study, the WCD wearing compliance was well-maintained in the outpatient setting. WCD is useful for patients at high risk of VTA.
