ANMCO position paper: guide to the appropriate use of the wearable cardioverter defibrillator in clinical practice for patients at high transient risk of sudden cardiac death

Figures

• 

  Figure 1. Flow chart showing the main conditions, indications for the use of the wearable cardioverter defibrillator, and subsequent clinical pathway (A) in patients with newly found 35% ejection fraction and (B) in patients at risk of sudden cardiac death. CAD, coronary artery disease; CMP, cardiomyopathy; LVEF, left ventricular ejection fraction; GDMT, guideline-guided medical therapy; ICD, implantable cardioverter defibrillator; AMI, acute myocardial infarction; LVAD, left ventricular assist device; OMT, optimal medical therapy; ACS, acute coronary syndrome; EPS, electrophysiological study; SVT, sustained ventricular tachycardia. *Suspected hereditary channelopathy or CMP judged to be high risk by history and symptoms pending diagnostic and therapeutic definition in selected cases. #ICD temporarily contraindicated: endocarditis, radiotherapy/chemotherapy, awaiting other treatment (e.g. surgery), and transient comorbidity (e.g. sepsis, anaemia, and hypokalaemia).

• 

  Figure 2. Screenshot of the wearable cardioverter defibrillator remote monitoring website where trends in heart rate, activity, body position, and body angle are visible when the patient is lying down.

• 

  Figure 3. Screenshot of the remote monitoring site of the wearable cardioverter defibrillator where the wearing time of the device can be checked.

• 

  Figure 4. Screenshot of the wearable cardioverter defibrillator remote monitoring website where the electrocardiographic recordings can be viewed, classified according to the following categories: ‘baseline’ (acquisition of the electrocardiographic signal upon delivery of the device), ‘manual’ recording (initiated by patient), ‘automatic’ recording (arrhythmias that did not lead to the delivery of a shock), ‘treatment’ (arrhythmias with shock delivery), and ‘asystole’.

• 

  Figure 5. Screenshot of the wearable cardioverter defibrillator’s remote monitoring website showing the results of the walk test in terms of distance travelled and heart rate trend during the individual test (right) and the variations over time between different walk tests performed for the parameters distance travelled and average heart rate (left).

• 

  Figure 6. Screenshot of the wearable cardioverter defibrillator remote monitoring website where the patient’s answers to the individual health questionnaire (left) and the trend of answers over time for each question (right) are displayed.