Experience With Wearable Cardioverter-Defibrillators at 2AcademicMedical Centers.

Abstract

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. The WCD is available for patients felt to be at high risk of sudden cardiac death. However, there is a lackof randomized data to guide its use and prescribing patterns vary. We retrospectively reviewed indications and therapies of all WCD prescriptions over a 2-year period from 2largeacademic medical centers. Data on compliance and treatment events of patients wearing the WCD were reviewed. 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 to22.8h). High-voltage treatment was delivered in 3 separate patients, 2 of whom died. The third patient received 3WCD shocks without restoration of a perfusing rhythm and ultimately was resuscitated by emergency responders. No patients received inappropriate therapies. 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.