Key result
In 436 patients using a wearable cardioverter-defibrillator under optimized medical therapy, no appropriate or inappropriate shocks were delivered and left ventricular ejection fraction significantly improved.
Why the study?
The study was conducted to review the safety and efficiency of wearable cardioverter-defibrillators under current guideline-directed medical therapy.
Does a wearable cardioverter-defibrillator provide lifesaving shocks and accurately detect arrhythmias in patients with heart failure under optimized guideline-directed medical therapy?
Observational (n=436)
No
Does a wearable cardioverter-defibrillator provide lifesaving shocks and accurately detect arrhythmias in patients with heart failure under optimized guideline-directed medical therapy?
Under optimized guideline-directed medical therapy, wearable cardioverter-defibrillators rarely deliver lifesaving shocks and have a low positive predictive value for ventricular tachycardia due to frequent artifacts.
The aim of the present study was to review the safety and efficiency of wearable cardioverter-defibrillators (WCDs) under current guideline-directed medical therapy (GDMT). We retrospectively analyzed 436 consecutive WCD patients seen in the years 2014-2020. Detected automatic arrhythmia alarm (AA) episodes were validated and classified as correct or incorrect. The positive predictive value (PPV) was calculated. GDMT was optimized in our outpatient clinic to maximal tolerated doses. During a total wear time (WT) of 23,527 days, 3,135 AAs were transmitted from 206 of 436 (47.2%) patients. Visual analysis revealed correct diagnoses of non-sustained ventricular tachycardia (VT) in 38 AAs from 6 patients (total PPV, 1.21%; PPV in VT patients, 41%); the remaining AAs were artifacts. No appropriate or inappropriate shocks and fatalities were recorded. LVEF significantly improved (P < .001) during the WT from 25% (range, 20%-30%) to 40% (range, 34%-46%). Defibrillators were implanted in 109 patients (27%). The PPV for VT of the WCD was very low. There were fewer instances of true VT than previously reported, and no shocks (appropriate or inappropriate) were delivered. The majority of patients greatly improved with GDMT, and device implantation rates were lower than previously reported. Improvements in arrhythmia detection algorithms are warranted. Based on our results, WCDs are rarely needed for lifesaving shocks under optimal GDMT.
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Nägele et al. (2022) conducted an observational in Heart failure and high risk of sudden cardiac death (n=436). Wearable cardioverter-defibrillator (WCD) was evaluated on Appropriate or inappropriate shocks and fatalities. In 436 patients using a wearable cardioverter-defibrillator under optimized medical therapy, no appropriate or inappropriate shocks were delivered and left ventricular ejection fraction significantly improved.
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