NATIONAL EXPERIENCE WITH WEARABLE CARDIOVERTER-DEFIBRILLATOR USE IN TAKOTSUBO CARDIOMYOPATHY

Abstract

Takotsubo cardiomyopathy (TCM) is generally a reversible cardiomyopathy with a favorable prognosis. Because of a risk of sudden cardiac death (SCD), a wearable cardioverter- defibrillator (WCD) is occasionally prescribed, although its utility is unknown. We reviewed a national database of TCM patients who were prescribed a WCD. The database collected baseline demographics, left ventricular ejection fraction (EF), usage compliance, documented arrhythmias, and final survival status. One-hundred and two patients with mean age 63i12 years, 11% men, had an initial EF of 27i7% at the time of WCD prescription. The mean days of use was 44i31 days, with an average daily hours used of 20i4 hours. The average follow-up period was 440i374 days and 95% of patients wore the WCD .90% of prescribed days. Two patients (2%) experienced shocks for ventricular arrhythmias (VAs) and survived; two patients (2%) experienced significant bradyarrhythmias; one patient received two inappropriate shocks due to signal artifact; no patients experienced a detection failure; two patients died during the prescription period: one with asystole, and one while not wearing the WCD; five patients died after discontinuing WCD usage, two of whom had an EF §35% at the time of WCD discontinuation. The WCD was used with a compliance of .90%. The device detected VAs reliably with a low risk of inappropriate shocks. TCM may be associated with a significant risk of death due to tachy- or bradyarrhythmias and the risk of SCD may persist even if the EF improves.