P263 EFFICACY AND SAFETY OF THE LIFEVEST® WEARABLE DEFIBRILLATOR IN PATIENTS WITH NEWLY DETECTED ISCHEMIC AND NONISCHEMIC HYPOKINETIC DILATED HEART DISEASE: EXPERIENCE FROM OUR CENTER

Abstract

Abstract Introduction The wearable defibrillator (WCD) is indicated in patients at risk of sudden cardiac death who do not have short term indication for implantation of a definitive device. Efficacy in the recognition and treatment of ventricular tachyarrhythmias has been demonstrated in the context of postinfarction ischemic heart disease, while little evidence is currently available in other clinical settings. The aim of the study was to evaluate the efficacy and safety of WCD in an unselected population of patients with ejection fraction (EF) <35% and newly detected myocardial infarction (MI) or nonischemic dilated cardiomyopathy (NIDCM) pending optimization of medical therapy. Methods All patients with FE <35% admitted to our department from 2017 to 2022 after MI or with newly found NIDCM and discharged with WCD (LifeVest® Zoll) were enrolled as part of a prospective registry. The indication was considered in patients with nonsustained ventricular arrhythmias during hospitalization. Clinical and medical history data were collected for each subject; follow–up was conducted until the end of device monitoring, recording any events and therapies delivered. Results Of the 22 subjects enrolled, 19 (86%) were male. The mean age was 57±10 years. Fifteen patients had newly encountered NIDCM (68.2%) and 7 had been discharged after MI. Ninety–five percent of patients were on beta–blockers, 68% on ACE inhibitors, 5% on Sartan, 32% on Sacubitril Valsartan, 81% on Antialdosteronics, 9% on SGLT2i. The mean duration of treatment was 68±33 days. A statistically significant increase in EF was observed at the end of treatment in the two subgroups (MI 40%±8 vs. 32%±3, p 0.03. NIDCM 39%±9 vs. 31%±6 p 0.002). No arrhythmic events or inappropriate discharges were recorded. At the end of treatment, 41% of patients had indication for definitive defibrillator implantation, with no difference in the two subgroups (MI 28% Vs NIDCM 46% p 0.115). Conclusions In a population of patients discharged on optimal medical therapy, a significant increase in EF at follow–up was observed with no significant differences in definitive ICD implantation between the subgroup of patients with recent MI or newly found NIDCM. WCD therapy was found to be safe in the absence of need for appropriate shocks.