Jordan S Leyton-Mange1, William J Hucker1, Nino Mihatov1, Matthew Reynolds2, Christine Albert3, Steven A Lubitz4, David J Milan5. 1. Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 2. Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts. 3. Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4. Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts. 5. Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dmilan@partners.org.
Abstract
OBJECTIVES: This study sought to characterize the experience in a cohort of patients prescribed a wearable cardioverter-defibrillator (WCD) over a 2-year interval at 2 academic medical centers. BACKGROUND: The WCD is available for patients felt to be at high risk of sudden cardiac death. However, there is a lack of randomized data to guide its use and prescribing patterns vary. METHODS: We retrospectively reviewed indications and therapies of all WCD prescriptions over a 2-year period from 2 large academic medical centers. Data on compliance and treatment events of patients wearing the WCD were reviewed. RESULTS: Among the 147 patients prescribed a WCD, 80% were male with an age of 59 ± 14 years. The WCD was prescribed for the following reasons: primary prevention in the setting of a left ventricular ejection fraction ≤35% (53%), secondary prevention when an implantable cardioverter-defibrillator was not implanted (16%), implantable cardioverter-defibrillator explantation (23%), and other high-risk scenarios for arrhythmic sudden death (9%). The median wear duration was 50 days (interquartile range [IQR]: 25 to 85 days) with a median of 21.0 h of wear per day (IQR: 15.0 to 22.8 h). High-voltage treatment was delivered in 3 separate patients, 2 of whom died. The third patient received 3 WCD shocks without restoration of a perfusing rhythm and ultimately was resuscitated by emergency responders. No patients received inappropriate therapies. CONCLUSIONS: Events requiring therapy were rare and no lives were directly saved by the WCD. Future efforts are needed to improve identification of patients most likely to benefit from a WCD.
OBJECTIVES: This study sought to characterize the experience in a cohort of patients prescribed a wearable cardioverter-defibrillator (WCD) over a 2-year interval at 2 academic medical centers. BACKGROUND: The WCD is available for patients felt to be at high risk of sudden cardiac death. However, there is a lack of randomized data to guide its use and prescribing patterns vary. METHODS: We retrospectively reviewed indications and therapies of all WCD prescriptions over a 2-year period from 2 large academic medical centers. Data on compliance and treatment events of patients wearing the WCD were reviewed. RESULTS: Among the 147 patients prescribed a WCD, 80% were male with an age of 59 ± 14 years. The WCD was prescribed for the following reasons: primary prevention in the setting of a left ventricular ejection fraction ≤35% (53%), secondary prevention when an implantable cardioverter-defibrillator was not implanted (16%), implantable cardioverter-defibrillator explantation (23%), and other high-risk scenarios for arrhythmic sudden death (9%). The median wear duration was 50 days (interquartile range [IQR]: 25 to 85 days) with a median of 21.0 h of wear per day (IQR: 15.0 to 22.8 h). High-voltage treatment was delivered in 3 separate patients, 2 of whom died. The third patient received 3 WCD shocks without restoration of a perfusing rhythm and ultimately was resuscitated by emergency responders. No patients received inappropriate therapies. CONCLUSIONS: Events requiring therapy were rare and no lives were directly saved by the WCD. Future efforts are needed to improve identification of patients most likely to benefit from a WCD.
Authors: Ahmad Masri; Ahmed M Altibi; Sebhat Erqou; Mohammad A Zmaili; Ala Saleh; Raed Al-Adham; Karam Ayoub; Moaaz Baghal; Laith Alkukhun; Amr F Barakat; Sandeep Jain; Samir Saba; Evan Adelstein Journal: JACC Clin Electrophysiol Date: 2019-01-30
Authors: Jeanne E Poole; Marye J Gleva; Ulrika Birgersdotter-Green; Kelley R H Branch; Rahul N Doshi; Tariq Salam; Thomas C Crawford; Mark E Willcox; Arun M Sridhar; Ghiath Mikdadi; Sean C Beinart; Yong-Mei Cha; Andrea M Russo; Ron K Rowbotham; Joseph Sullivan; Laura M Gustavson; Kaisa Kivilaid Journal: J Cardiovasc Electrophysiol Date: 2022-02-28 Impact factor: 2.942