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

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.

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

Journal of Clinical Medicine ◽

10.3390/jcm9030893 ◽

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.

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

EP Europace ◽

10.1093/europace/euaa162.296 ◽

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0407 ◽

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

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

Circulation ◽

10.1161/circ.130.suppl_2.18973 ◽

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.

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Abstract 092: No Change in Peripartum Cardiomyopathy Outcomes or Risk Factors Over the Past Decade

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.092 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Nivedita Basu ◽

Madeline Mahowald ◽

Kris Kawamoto ◽

Melinda Davis

Keyword(s):

Risk Factors ◽

Maternal Age ◽

Care Center ◽

Tertiary Care ◽

Temporal Trends ◽

Peripartum Cardiomyopathy ◽

Icd Implantation ◽

The Past ◽

Increased Risk

Background: Few studies have evaluated temporal trends in outcomes and risk factors for peripartum cardiomyopathy (PPCM). Prior research using administrative data could only assess short-term in-hospital adverse events. It has also been hypothesized that the incidence of PPCM is rising due to advancing maternal age and increased risk factors. Therefore, we examined long-term outcomes and prognostic factors to determine if there has been any change over the past decade. Methods: Patients seen at a tertiary care center between 2000 and 2011 with a diagnosis of PPCM were identified by ICD9 code 674.5x and confirmed by manual chart review. Year of diagnosis, clinical and demographic variables, echocardiographic data, and outcomes including myocardial recovery (defined as EF>=55%), ICD placement, LVAD, transplant, and death were reviewed for follow-up through November 2016. Results: Of 60 patients, 31 (52%) were diagnosed recently (2006-2011) and 29 (48%) were diagnosed prior to 2006 (1996-2005). There were no significant differences in the recent group compared to the past group in initial EF (19% vs 22%), final EF (39% vs 39%), and final recovery status (52% vs 48%). Similarly, there were no differences in rates of ICD implantation, LVAD/transplant, mortality, and years of survival. There were no differences in age at diagnosis or in rates of hypertension, smoking, or diabetes. Few patients in either category underwent a subsequent pregnancy. Mean years of follow-up (through 2016) were longer for those diagnosed prior to 2006 (8.3 years vs 3.4 years, p<0.001). Conclusions: There has been no improvement in outcomes for patients diagnosed with PPCM in the past decade. Maternal age and risk factors do not appear to be increasing. Despite advances in heart failure treatment and increased awareness of PPCM, more research about the management and follow-up of young mothers with PPCM is needed.

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A Comparison of Cyclophosphamide, Bortezomib, and Dexamethasone Versus Bortezomib and Dexamethasone in Transplant Eligible Patients with Newly Diagnosed Multiple Myeloma

Blood ◽

10.1182/blood.v128.22.4519.4519 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4519-4519

Author(s):

Amarilis Figueiredo ◽

Harold Atkins ◽

Ranjeeta Mallick ◽

Natasha Kekre ◽

Andrea Kew ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Care Center ◽

Tertiary Care ◽

Median Number ◽

Categorical Variables ◽

Cell Transplant ◽

Tertiary Care Center ◽

Newly Diagnosed

Abstract Introduction Cyclophosphamide, bortezomib, and dexamethasone (CyBor-D) is considered a standard induction regimen for transplant eligible patients with newly diagnosed multiple myeloma (MM) based primarily on phase 2 data. It has not been directly compared to bortezomib and dexamethasone (Bor-Dex) alone. Therefore, we sought to compare the efficacy CyBor-D and Bor-Dex induction in transplant eligible patients treated at a tertiary care center. Methods A retrospective observational study was performed from a single tertiary care center between January 1, 2008 and April 30, 2016. All transplant eligible patients with MM who received induction chemotherapy with CyBor-D or Bor-Dex and were included. The primary outcome was progression free survival (PFS). Secondary outcomes were response to induction, toxicity, stem cell collection yield and failures, and response to autologous stem cell transplant (autoSCT). Continuous variables were reported as median and compared using Mann-Whitney test. Categorical variables were compared using Pearson's chi-square test. PFS was estimated with Kaplan-Meier. Results One hundred and fifty nine patients were included, 82 (51.6%) treated with CyBor-D and 77 (48.4%) treated with Bor-Dex. The relative proportion of patients treated with CyBor-D increased annually: 1/23 (4%) in 2012, 20/30 (66%) in 2013, 33/34 (97%) in 2014, and 28/28 (100%) in 2015. Patient demographics and disease characteristics were similar between all groups for sex, subtype of MM and stage by the International Staging System. The Bor-Dex group was significantly younger than the CyBor-D group (mean age 56 vs. 61 years, p < 0.001). Median number of cycles was the same for both groups (4, p= 0.73); however, the Bor-Dex group was more likely to have treatment held, reduced or discontinued than the CyBor-D group (19.7% vs. 6.4%, p=0.017). The overall response rate (ORR) was similar between both groups, 88.5% for CyBor-D and 82.7% for Bor-Dex (p=0.36), but patients treated with CyBor-D had deeper responses to induction with 57.5% achieving ≥VGPR whereas 38.7% in the Bor-Dex group achieved ≥ VGPR (p=0.02). The stem cell mobilization regimen was predominantly Cyclophosphamide and GCSF for both groups. Plerixafor use was more common in the CyBor-D cohort, 14.6% vs. 1.3% in Bor-Dex (p=0.002), and there were more collection failures in the CyBor-D group compared to Bor-Dex (6.1% vs. 0%, p=0.03). The median number of CD34 cells collected was higher in the Bor-Dex compared to CyBor-D (9.88 x 106 cells/kg vs. 7.66 x 106cells/kg, p=0.004), however median collection days was similar (1 in both groups, p=0.175). The mobilization toxicity was similar between both groups with a trend towards increased hospitalizations in the CyBor-D group (26% vs. 14%, p=0.075). The conditioning regimen was the same in both groups, predominantly Melphalan 200 mg/m2. Day 100 response was similar, with 76.7% of CyBor-D patients achieving ≥ VGPR vs. 71.21% for Bor-Dex (p= 0.25). The median PFS was 36.5 months in the Bor-Dex group and not yet reached in the CyBor-D group, due to shorter follow up time. However, the percentage of patients free from relapse was similar at 1 year (92.8% for CyBorD vs 98.7% for Bor-Dex) and at 2 years (69.4% for CyBor-D vs 72.9% for Bor-Dex). Conclusions CyBor-D and Bor-Dex appear to have similar overall efficacy for newly diagnosed transplant eligible patients with multiple myeloma in our cohort. CyBor-D was associated with deeper response to induction, but after autoSCT there was no difference in the depth of response between the two cohorts. Longer follow up is required to detect if the deeper response to induction with CyBor-D leads to differences in PFS. When used with Cyclophosphamide-GCSF mobilization, CyBor-D appears to result in more collection failures and a trend towards increased hospitalizations. Further prospective studies are required to examine this relationship. Disclosures Kew: Celgene: Honoraria. McCurdy:Celgene: Honoraria.

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

European Heart Journal ◽

10.1093/eurheartj/ehz748.0757 ◽

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.

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2403Experience with the wearable cardioverter-defibrillator by disease etiology: results from the wearit-II registry

European Heart Journal ◽

10.1093/eurheartj/ehz748.0156 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Kutyifa ◽

K Vermilye ◽

W Zareba ◽

S McNitt ◽

I Goldenberg

Keyword(s):

Ventricular Arrhythmias ◽

Ischemic Cardiomyopathy ◽

Icd Implantation ◽

Disease Etiology ◽

Cardioverter Defibrillator ◽

Wear Time ◽

Ischemic Group ◽

Wearable Cardioverter Defibrillator ◽

Time Period ◽

Research Grant

Abstract Background The use of the wearable cardioverter-defibrillator (WCD) in patients with non-ischemic cardiomyopathy has been less characterized. Objective We aimed to characterize WCD use and outcomes for patients with ischemic or non-ischemic cardiomyopathy, enrolled in the WEARIT-II Registry. Methods In WEARIT-II, we stratified 1,732 patients into ischemic (n=805) and non-ischemic etiology (n=927). WCD wear time, arrhythmia events during WCD use, and implantable cardioverter-defibrillator (ICD) implantation rates, or ejection fraction (EF) improvement at the end of WCD were evaluated for etiology subgroups. Results The WCD median wear time was higher in patients with non-ischemic cardiomyopathy (93 vs. 87 days, p=0.003), however daily use was similar (22.4 vs. 22.6 hours, p=0.07). There were 24 ischemic patients (3%) with sustained VT/VF events compared to 10 patients (1%) with non-ischemic cardiomyopathy (p=0.013). About 2/3 of these events were treated with WCD shock in ischemic patients, half of them in the non-ischemic group (1.9% vs. 0.4%). Atrial arrhythmias were frequent in both groups (3.1% vs. 3.1%, p=0.06). At the end of WCD use, 36% of the non-ischemic patients were implanted with an ICD compared to 42% in ischemic (p=0.01), likely due to the lower rate of sustained ventricular arrhythmias (Figure). Figure 1 Conclusions In WEARIT-II, patients with non-ischemic cardiomyopathy had longer WCD use than ischemic patients with good compliance. The rate of sustained ventricular arrhythmia events was lower in non-ischemic patients avoiding the need for an ICD implantation in more patients compared to ischemic, following a time period of risk stratification. Acknowledgement/Funding WEARIT-II was funded by an unrestricted research grant from ZOLL Inc.

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Factors That Cause Concerns after Cardioverter Defibrillator Implantation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116095 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6095

Author(s):

Olimpia Karczewska ◽

Agnieszka Młynarska

Keyword(s):

Observational Study ◽

Secondary Prevention ◽

Negative Emotions ◽

Female Gender ◽

Multiple Regression Model ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Input Method ◽

Two Stages

Background and Objectives: The aim of the study was to assess the factors that influence the occurrence of concerns and their intensification after the implantation of a cardioverter defibrillator. Materials and Methods: This was a prospective and observational study including 158 patients. The study was conducted in two stages: stage I before implantable cardioverter defibrillator (ICD) implantation and stage II follow-up visit six months after ICD implantation. Standardized questionnaires were used in both stages. Results: Age and female gender were significantly correlated with the occurrence and intensity of concerns. Patients who had a device implanted for secondary prevention also experienced higher levels of concern. Additionally, a multiple regression model using the stepwise input method was performed. The model was statistically significant and explained 42% of the observed variance in the dependent variable (p = 0.0001, R2 = 0.4215). The analysis showed that age (p = 0.0036), insomnia (p = 0.0276), anxiety (p = 0.0000) and negative emotions (p = 0.0374) were important predictors of the dependent variable and enabled higher levels of the number of concerns to be predicted. Conclusions: There is a relationship between the severity of the concerns related to an implanted ICD and age, gender, anxiety, negative emotions and insomnia. Indications for ICD implantation may be associated with increased concerns about ICD.

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Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

European Neurology ◽

10.1159/000514826 ◽

2021 ◽

pp. 1-8

Author(s):

Halil Celik ◽

Sadettin Burak Acikel ◽

Fatih Mehmet Akif Ozdemir ◽

Erhan Aksoy ◽

Ulkuhan Oztoprak ◽

...

Keyword(s):

Neurological Disease ◽

Chronic Conditions ◽

Care Center ◽

Tertiary Care ◽

Anxiety Level ◽

Childhood And Adolescence ◽

Routine Examination ◽

Significant Difference ◽

Anxiety Levels

Background and Aim: Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. Methods: The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. Results: There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. Conclusion: Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

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