Key result
Wearable cardioverter-defibrillator therapy achieves ~99% first-shock VT/VF success with long-term survival comparable to ICDs.
Why the study?
Effectiveness of the wearable cardioverter-defibrillator for sudden death prevention depends on event type, patient compliance, and appropriate management of VT/VF, but aggregate clinical experience needed evaluation.
What is the patient compliance, antiarrhythmic efficacy for VT/VF, and survival of patients prescribed a wearable cardioverter-defibrillator compared to patients receiving an implantable cardioverter-defibrillator?
Cohort (n=3,569)
Yes
What is the patient compliance, antiarrhythmic efficacy for VT/VF, and survival of patients prescribed a wearable cardioverter-defibrillator compared to patients receiving an implantable cardioverter-defibrillator?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Until recently, data regarding the incidence of sudden death and the utility of a wearable defibrillator for patients in these specific scenarios were scant. Also, patient compliance with this device on a large-scale level was a concern.”
In a large US nationwide registry, the wearable cardioverter-defibrillator demonstrated high patient compliance (>90% daily wear time in over half of patients), 99% first-shock efficacy for VT/VF, and survival comparable to implanted ICD patients, supporting its role as a temporary bridge when ICD implantation is deferred.
OBJECTIVES: The purpose of this study was to determine patient compliance and effectiveness of antiarrhythmic treatment by the wearable cardioverter-defibrillator (WCD). BACKGROUND: Effectiveness of the WCD for prevention of sudden death is dependent on event type, patient compliance, and appropriate management of ventricular tachycardia/ventricular fibrillation (VT/VF). METHODS: Compliance and events were recorded in a nationwide registry of post-market release WCDs. Survival, using the Social Security Death Index, was compared with survival in implantable cardioverter-defibrillator (ICD) patients. RESULTS: Of 3,569 patients wearing the WCD (age 59.3+/-14.7 years, duration 52.6+/-69.9 days), daily use was 19.9+/-4.7 h (>90% of the day) in 52% of patients. More days of use correlated with higher daily use (p<0.001). Eighty sustained VT/VF events occurred in 59 patients (1.7%). First-shock success was 76 of 76 (100%) for unconscious VT/VF and 79 of 80 (99%) for all VT/VF. Eight patients died after successful conversion of unconscious VT/VF (89.5% survival of VT/VF events). Asystole occurred in 23 (17 died), pulseless electrical activity in 2, and respiratory arrest in 1 (3 died), representing 24.5% of sudden cardiac arrests. During WCD use, 3,541 of 3,569 patients (99.2%) survived overall. Survival occurred in 72 of 80 (90%) VT/VF events and 78 of 106 (73.6%) for all events. Long-term mortality was not significantly different from first ICD implant patients but highest among patients with traditional ICD indications. CONCLUSIONS: Compliance was satisfactory with 90% wear time in >50% of patients and low sudden death mortality during use. Survival was comparable to that of ICD patients. However, asystole was an important cause of mortality in sudden cardiac arrest events.
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Chung et al. (2010) conducted a cohort in Temporary or fluctuating high risk for sudden cardiac death with deferred ICD implantation (n=3,569). Wearable cardioverter-defibrillator (WCD) vs. First implantable cardioverter-defibrillator (ICD) implantation patients from Cleveland Clinic was evaluated on First-shock conversion success for sustained VT/VF events and overall survival during WCD use (p=0.707). Wearable cardioverter-defibrillator therapy achieved 99% (79/80) first-shock VT/VF success, 99.2% overall acute survival during use, and long-term survival comparable to ICD patients (p=0.707).
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