scholarly journals The Wearable Cardioverter/ Defibrillator: retrospective analysis of efficacy, safety and adherence

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Ehmsen ◽  
H Keller ◽  
C Stoellberger
Keyword(s):  
Systolic Function ◽  
Detection Algorithm ◽  
Shock Rate ◽  
Information Network ◽  
Independent Data ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
High Adherence

Abstract Background The use of the Wearable Cardioverter Defibrillator (WCD) is recommended in national, European and American guidelines. However, there are almost exclusively data from the manufacturer's own data network. Independent data on the experience with the WCD are rare. Objective The aim of the retrospective study from one cardiologic department was to record efficiency, safety and compliance of the WCD. Patients and methods The study included all patients, to whom a WCD was described between 1.11.2010 and 1.5.2018 at one cardiologic department. Clinical data were obtained from the patients' records and the data about the WCD from the information network of the manufacturer. Results This study enrolled 66 patients, 51 males (77%) and 15 females (23%). The median age was 55 years (IQR: 45–63). They suffered from ischemic cardiomyopathy (n=33; 49%), dilated cardiomyopathy (n=12; 18%), myocarditis (n=7; 11%), explantation of an implantable cardioverter/defibrillator (ICD; n=5; 8%) and other indications (n=6; 9%). The median wearing time of the WCD was 73 days (interquartile range-IQR: 39–126), with median daily use of 22.91 h (IQR: 19.58–23.61). Among 38 patients with LVEF ≤35%, LVEF improved to ≥35% in 19 patients (50%) during WCD therapy. Over 1600 times the WCD detected a VT falsely. Four patients (8%) suffered from 212 non-sustained VT. One patient was successfully shocked because of ventricular fibrillation (appropriate shock rate: 1.5%). There were no inappropriate shocks. All patients, who wore the WCD, survived and one patient died when he did not wear the WCD. At the end of therapy 32 patients (48%) received an ICD. In terms of wearing time and events (shocks, arrhythmias, artifacts) there were no significant differences between patients receiving ICD and those who did not receive an ICD. Patients who received an ICD had a significantly lower LVEF after 3 months than patients who did not receive an ICD. Conclusion Our data confirm, that the WCD is safe and that the patients, who wear a WCD, have a high adherence. More than half of the patients with reduced LVEF improved their systolic function during WCD therapy, thus obviating the need for ICD implantation. Questions about the effectiveness of the detection algorithm remained open. Funding Acknowledgement Type of funding source: None

Abstract 12637: Utility of the Wearable Cardioverter-Defibrillator for Patients With Newly Diagnosed Non-Ischemic Cardiomyopathy?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Madhurmeet Singh ◽  
Krishna Alluri ◽  
Andrew Voigt ◽  
Norman Wang ◽  
Sandeep Jain ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Beta Blockers ◽  
Care Center ◽  
Tertiary Care ◽  
Newly Diagnosed ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Inappropriate Shocks

Introduction: The wearable cardioverter-defibrillator (WCD) is approved for prevention of sudden cardiac death in patients with newly diagnosed cardiomyopathy and LVEF < 35% who do not yet meet criteria for implantation of an implantable cardioverter-defibrillator (ICD). While there are some data supporting WCD use in patients with ischemic cardiomyopathy (ICM), data in patients with nonischemic cardiomyopathy (NICM) are lacking. Methods: This was a retrospective review of outcomes for all NICM patients prescribed a WCD at a large tertiary academic center from 6/2004 - 1/2014 for a newly diagnosed cardiomyopathy and no prior sustained ventricular arrhythmia. During this time period, 454 patients were prescribed a WCD, of whom we excluded 161 patients with ICM. Results: The 183 (40%) patients with NICM consisted of 70% men, aged 57 +/- 15 years old, with mean EF 23% +/- 8% and LV end-diastolic dimension 4.5 +/- 2.8 cm. DM and HTN were prevalent (20% and 51%, respectively). At NICM diagnosis, 21% had LBBB and 36% had known history of AF. Patients wore the WCD for 13,124 patient-days, each averaging 72 +/- 55 days and with fairly high compliance (18.3 +/- 5.7 hours/day). Medication use consisted of 90% beta-blockers, 88% ACE inhibitors, 85% diuretics, 16% digoxin, and 17% anti-arrhythmic drugs. NSVT was documented in 42% of patients prior to WCD prescription. During follow-up, 60 (33%) patients improved LVEF to > 35%, obviating an indication for ICD implantation, whereas 79 (43%) patients received an ICD. The remainder died (n=17), were lost to follow-up (n=20), refused ICD implant (n=5), or are still wearing the WCD (n=2). No appropriate WCD shocks were delivered in any NICM patient, yet 3 inappropriate shocks were delivered (1.6%). Based on estimated rental costs provided by the manufacturer, the total cost of WCD use in this population was $1,449,360. Conclusions: In this large, tertiary care center registry of patients with newly recognized NICM, no patient received an appropriate shock from the WCD whereas several inappropriate shocks were delivered, despite nearly one-half of patients having documented significant ventricular ectopy. Given the significant expense and inconvenience of the WCD, its use in this population requires prospective study.

P2280Incidence and predictors of alarms in patients with wearable cardioverter defibrillator (WCD) - results of the Austrian WCD Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Rohrer ◽  
M Manninger ◽  
T Odeneg ◽  
C Ebner ◽  
D Moertl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Option ◽  
Normal Sinus Rhythm ◽  
Effective Treatment Option ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
Normal Sinus ◽  
Appropriate Shocks

Abstract Background The wearable cardioverter-defibrillator (WCD) is a treatment option for patients at high risk for ventricular arrhythmia, either if the risk is potentially reversible or if an implantable cardioverter defibrillator (ICD) implantation is currently not possible. Methods We performed a retrospective analysis of all alarms in the cohort of the Austrian WCD registry between 2010 and 2018. Type of arrhythmias was assessed by independent review of two cardiologists. Results 25.540 automatically recorded ECGs in 605 patients (68%) were analyzed. 1125 ECGs showed sustained ventricular arrhythmias in 117 patients, 65 ECGs showed non sustained VTs. 24.415 ECGs in 488 patients showed inadequate alarms Reasons for inadequate alarms were artefacts (97%), pacemaker or t-wave oversensing (0,3%) and in 2,3% atrial fibrillation or SVTs. 5860 manually recorded ECGs in 608 patients (68%) were analyzed. 298 (5%) of these ECGs showed following arrhythmias: atrial fibrillation (34,7%), SVTs (28%), sinustachycardia (10,7%), non sustained VTs (12%) and sustained VTs or sustained slow VTs (6,7%), premature ventricular beats or bradycardia was identified in 8%. The remaining 5562 ECGs (95%) showed normal sinus rhythm. Of the 895 patients (60±14 years, 20% female), 34 (3,8%) received a total of 65 automatically triggered shocks (median 2; range 1–5). 31/895 (3.5%) patients received 57 appropriate shocks (median 1, range 1–5) for 49 arrhythmic events, whereas 7/895 (0.8%) patients received 8 inappropriate shocks (median 1, range 1–2). 44 events were successfully terminated with the first shock (85,7%) and 4 events were terminated with the second shock. In one patient, a shock treatment for VF was not successful. The time from event onset to shock was median 60 [40; 1187] sec. The median time from WCD prescription to a shock event was 8 days [1–151]. 23/ 34 patients (68%) received their first WCD shock within 30 days. Seven patients (0.8%) received a total of nine inappropriate shocks due to different reasons: artefacts (2 inappropriate shocks), non-shockable rhythms (asystole, weak action, 3 shocks) and atrial fibrillation with a bundle branch block in two cases. In one patient VF terminated spontaneously before the WCD treatment was delivered. Conclusion The WCD is an effective treatment option in patients with a high SCD risk but it also triggers a significant amount of alarms. Although many inadequate alarms occurred, adequate alarms led to arrhythmia detection such as in VT/VF events which were successfully terminated by the WCD in 3,4% of patients.

Abstract 18973: Left Ventricular Function Improvement After Recent MI in Patients Using a Wearable Cardioverter Defibrillator

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chingping Wan ◽  
Steven J Szymkiewicz
Keyword(s):  
Heart Failure ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Clinical Characteristics ◽  
Treated Group ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator

Introduction: The wearable cardioverter defibrillator (WCD) has been used to protect AMI patients with reduced LVEF (≤35%) until ICD evaluation is recommended. The rate of EF improvement (e.g. EF>35%) over the initial 8-12 weeks after AMI has not been reported. METHODS: The manufacturer-maintained registry was searched for AMI patients who received a WCD shock for VT/VF between 05/2008 and 02/2013. The treated group was matched (1: ~4) with event-free WCD patients by ICD-9 code (410.*), gender, age and prescription date. Chart notes were reviewed for clinical characteristics. Follow-up was assessed through the registry and Social Security Death Master File. RESULTS: There were 992 (age=63±12, female=20.2%) AMI patients included in the final analysis, 206 treated by WCD and 786 event-free patients. Median follow-up was 334 days. Mean length of WCD use was 67±506 (median=38) days. Subgroup clinical characteristics are presented in Table 1. In the event-free group, 289 (38.9%) patients showed EF improvement to >35%. Nine (4.5%) in the treated group continued wearing the WCD until EF recovery, while 125 (60.7%) received ICD. Absence of recorded heart failure and/or diabetes were associated with LVEF recovery (p<.0001). CONCLUSION: In our study, almost 40% of AMI patients with initial EF ≤35% had EF improvement in two months. The EF recovery group had lower rates of heart failure and diabetes. WCD allows time for left ventricular function recovery in low EF post MI patients, optimizing ICD implantation decisions.

scholarly journals LEFT VENTRICULAR LEAD IMPLANTATION FOR DETECTION OF VENTRICULAR ARRHYTHMIAS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AND LOW R WAVE IN RIGHT VENTRICLE

2021 ◽  
pp. 17
Author(s):  
Keyword(s):  
Sudden Cardiac Death ◽  
Right Ventricle ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Systolic Function ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Ventricular Lead

Dilated cardiomyopathy (DCM) is a disease characterised as left ventricular (LV) or biventricular dilatation with impaired systolic function. Regardless of underlying cause patients with DCM have a propensity to ventricular arrhythmias and sudden cardiac death. Implantable Cardioverter Defibrillator (ICD) implantation for these patients results in significant reduction of sudden cardiac death [1-3]. ICD devices may be limited by right ventricle (RV) sensing dysfunction with low RV sensing amplitude. We present a clinical case of patient with DCM, implanted ICD and low R wave sensing on RV lead.

scholarly journals Patients with history of atrial fibrillation have significantly more inappropriate shocks after cardioverter-defibrillator (ICD) implantation

EP Europace ◽  
2001 ◽  
Vol 2 (Supplement_1) ◽  
pp. A48-A48
Author(s):  
A Przybylski ◽  
M Sterliński ◽  
M Lewandowski ◽  
M Pytkowski ◽  
A Kurowski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
History Of

scholarly journals High Incidence of Inappropriate Alarms in Patients with Wearable Cardioverter-Defibrillators: Findings from the Swiss WCD Registry

2021 ◽  
Vol 10 (17) ◽  
pp. 3811
Author(s):  
Boldizsar Kovacs ◽  
Haran Burri ◽  
Andres Buehler ◽  
Sven Reek ◽  
Christian Sticherling ◽  
...  
Keyword(s):  
Implantation Rate ◽  
Treatment Sequence ◽  
Cardioverter Defibrillator ◽  
Wear Time ◽  
Surface Electrodes ◽  
Wearable Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
High Incidence ◽  
Episode Duration ◽  
Cardioverter Defibrillators

Background: The wearable cardioverter defibrillator (WCD) uses surface electrodes to detect arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts. Objective: The aim of this study is to assess the alarm burden in patients and its impact on clinical outcomes. Methods: Patients from the nationwide Swiss WCD Registry were included. Clinical characteristics and data were obtained from the WCDs. Arrhythmia recordings ≥30 s in length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia (SVT) or artefact. Results: A total of 10653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0 ± 1.6 months. Episode duration was 30 s or more in 2996 alarms (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) SVT). Two-hundred and seven patients (45%) had three or more alarms per month. Obesity was significantly associated with three or more alarms per month (p = 0.01, 27.7% vs. 15.9%). High alarm burden was not associated with a lower average daily wear time (20.8 h vs. 20.7 h, p = 0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs. 47.3%, p = 0.156). Conclusions: In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden was associated with obesity but did not lead to a decreased adherence.

scholarly journals The Wearable Cardioverter-Defibrillator: Experience in 153 Patients and a Long-Term Follow-Up

2020 ◽  
Vol 9 (3) ◽  
pp. 893
Author(s):  
Stephanie L. Rosenkaimer ◽  
Ibrahim El-Battrawy ◽  
Tobias C. Dreher ◽  
Stefan Gerhards ◽  
Susanne Röger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Ischemic Cardiomyopathy ◽  
Ventricular Tachyarrhythmias ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
All Cause Mortality ◽  
Long Term Follow Up

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.

911Which patients are most likely to benefit from the wearable cardioverter-defibrillator? Findings from the Swiss WCD registry

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Kovacs ◽  
S Reek ◽  
A Linka ◽  
P Ammann ◽  
A S Mueller ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Cardiomyopathy ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wear Time ◽  
Wearable Cardioverter Defibrillator ◽  
Time Period ◽  
Appropriate Therapy ◽  
The Mean

Abstract OnBehalf Swiss WCD Registry Introduction  The wearable cardioverter-defibrillator (WCD) has established itself as a temporary protection from sudden arrhythmogenic death in selected patients at risk. However, it is still of debate which patients and for what duration benefit from its use. Therefore, appropriate patient selection is key. Purpose: This study reports the results of the Swiss WCD registry with an emphasis on implantable cardioverter-defibrillator (ICD) implantation rate and ICD therapies. Methods  We retrospectively reviewed the indications, baseline characteristics and administered therapies in patients prescribed a WCD at 12 participating centers rom 2014 until 2018 in Switzerland. Further data on medical therapy, WCD therapy adherence, and ICD implantation rates were collected.  Results  456 patients were included in our study comprising of 66% of all Swiss patients prescribed a WCD in the examined time period. The mean age was 57 ±14 years, 18% were female and the mean ejection fraction (EF) was 32% ± 13. Indications for WCD use and appropriate shock rate are shown in the figure. Patients wore the WCD over a median of 58 days (range 1-455) with a median daily average wear-time of 22.6 hours (range 0.6-23.8). 17 appropriate therapies were administered by the WCD to a total of 12 patients leading to a therapy rate of 2.6% over a median wear-time of 16 days (range 2-79) and to a therapy rate of 3.9% in patients with ischemic cardiomyopathy (ICM) with an EF ≤35%. ICM with an EF ≤35% and bridging to ICD-implantation or heart transplantation as indication for WCD prescription were significantly associated with an appropriate therapy (p = 0.046 and 0.003, respectively). One patient with non-ischemic cardiomyopathy (NICM) received an appropriate therapy (0.8%). The mean EF in patients receiving an appropriate therapy by the WCD was also significantly lower (p = 0.04). No patient with wearing the WCD for congenital/inherited heart disease or risk stratification with an EF &gt;35% had a therapy administered by the WCD. There were no inappropriate therapies during the investigated time period. After cessation of WCD use EF improved to 38% ±13; ultimately, 212 patients (46%) were implanted with an ICD. During a follow-up of 476 days (range 7-2347) 22 (9.8%) patients received an appropriate therapy by their ICD. Four of the 22 had prior appropriate therapy by the WCD. Conclusions  ICM with severely reduced EF was the most common indication for WCD use leading to a high rate of appropriate therapy by the WCD. This, however, did not translate in a higher rate of appropriate ICD-therapies during follow-up in this subpopulation possibly due to significant improvements in their ejection fractions. Patients with NICM or congenital/inherited heart disease seldom had an appropriate therapy by the WCD. Abstract Figure. Indications for WCD use and therapy rate

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