Experience With the Wearable Cardioverter-Defibrillator

Aug 31, 2016
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Authors:
Wäßnig NK, Günther M, Quick S, et al.
Citation:
Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death. Circulation 2016;134:635-643.
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

What is the experience with wearable cardioverter-defibrillators (WCDs) among German patients?

Methods:

This was a retrospective analysis of 6,043 WCD patients (median age, 57 years; male, 78.5%) recruited from 404 centers in Germany.

Results:

There were 94 (1.6%) patients treated by the WCD in response to ventricular tachyarrhythmia/fibrillation (VT/VF). The overall incidence rate and 95% confidence interval of VT/VF was 8.4 [6.8, 10.2] per 100 patient-years. Patients with implantable cardioverter-defibrillator (ICD) explantation had a higher incidence rate of 19.3 [12.2, 29.0] per 100 patient-years. In contrast, an incidence rate of 8.2 [6.4, 10.3] was observed in the remaining cardiac diagnosis groups. Among 120 shocked patients, 112 (93%) survived 24-hour post-treatment, while asystole was observed in two (0.03%) patients with one resulting death.

Conclusions:

This large cohort represents the first nationwide evaluation of WCD use in patients outside the United States, and confirms the overall value of the WCD in German treatment pathways.

Perspective:

In observational studies, WCDs have been found to prevent arrhythmic death in a variety of clinical scenarios. The present study is consistent with prior literature confirming efficacy and patient compliance with the therapy. An American Heart Association (AHA) Science Advisory issued earlier this year gave the WCDs a Class IIa indication in case of ICD infection or as a bridge to transplantation, and Class IIb indication for newly diagnosed left ventricular dysfunction, potentially reversible cardiomyopathy, as well as within 40 days of myocardial infarction. The present study shows that patients following ICD explantation are more than twice as likely to receive appropriate therapy from the WCD than other patient groups, which supports the AHA Science Advisory recommendations.

Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Death, Sudden, Cardiac, Defibrillators, Defibrillators, Implantable, Electric Countershock, Heart Arrest, Heart Failure, Myocardial Infarction, Secondary Prevention, Tachycardia, Ventricular, Ventricular Dysfunction, Left, Ventricular Fibrillation


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