Abstract
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.
Highlights
The wearable cardioverter defibrillator (WCD), manufactured by ZOLL (Pittsburgh, PA, USA) is available for patients at high risk of sudden cardiac death (SCD)
The most common reason not to implant an implantable cardioverter-defibrillator (ICD) was improvement in left ventricular function, predominantly in patients with non-ischemic cardiomyopathy (NICM) (55% of all improved patients). In this context we showed that the majority of patients did not suffer from any kind of ventricular tachyarrhythmia events during wearable cardioverter-defibrillator (WCD) use (94%) nor did receive ICD shocks due to ventricular arrhythmias after subsequent device implantation (87%)
Two patients of whom suffered from appropriate WCD shocks (n = 6) experienced appropriate ICD shocks due to ventricular arrhythmias post implantation (33%)
Summary
The wearable cardioverter defibrillator (WCD), manufactured by ZOLL (Pittsburgh, PA, USA) is available for patients at high risk of sudden cardiac death (SCD). In patients with newly diagnosed heart failure or in patients soon after MI with or without myocardial revascularization therapy, LVEF may improve after time especially with optimal medical treatment (OMT) This has an impact on decision making regarding persistent risk of sudden cardiac death and need for ICD implantation over time. Recent data even suggest a prolonged period of more than 3 months with OMT before ICD implantation in patients with newly diagnosed non-ischemic cardiomyopathy (NICM) and ICM due to the possibility of delayed improvement of LVEF [8,9]. 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. All patients with ventricular tachyarrhythmias during WCD use or after ICD implantation survived the follow-up period. Patient selection regarding predictive conditions on long-term risk of ventricular tachyarrhythmias needs further risk stratification
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