Key result
WCD monitoring safely allows ~50% of at-risk patients to avoid permanent ICD implantation.
Why the study?
The effectiveness and safety of wearable cardioverter-defibrillator (WCD) therapy in patients with myocarditis and de novo heart failure or ventricular arrhythmias require further assessment.
Is wearable cardioverter-defibrillator therapy safe and effective for monitoring patients at risk of sudden cardiac death?
Observational (n=18)
No
Is wearable cardioverter-defibrillator therapy safe and effective for monitoring patients at risk of sudden cardiac death?
In a small retrospective cohort, wearable cardioverter-defibrillator use was safe and well-tolerated over a median of 77 days, with no deaths and no appropriate shocks delivered due to patient deferral.
May support bridging to avoid ICD in small cohorts; leaves open need for randomized trials to confirm benefit.
Assessment of WCD effectiveness and safety 1 as median and interquartile range (IQR).Categorical data were expressed as numbers and percentages.The Wilcoxon test was used to compare the baseline and final left ventricular ejection fraction (LVEF) values.When appropriate, categorical variables were compared using the χ 2 or Fisher exact test.Correlations between selected quantitative variables were assessed using the Spearman rank correlation test.The data were analyzed using the STATISTICA 13 software (TIBCO Software Inc., Palo Alto, California, United States). ResultsThe study group included 18 patients at a median (IQR) age of 40 (33-53) years, with male predominance (n = 15; 83%).Descriptive characteristics of the study group and the outcomes of the WCD application are presented in TAbLE 1.The most prevalent indication for the use of WCD in the analyzed group was myocarditis with de novo heart failure (HF) and / or VT/VF (n = 8; 44.4%).The most common comorbidities were HF (n = 15), hypertension (n = 6), and atrial fibrillation (n = 6).Median (IQR) LVEF was 26% (20%-38%) at the time of WCD application, and 45% (30%-50%) after the monitoring was completed; however, this change was not significant (P = 0.06).Median (IQR) monitoring time of the WCD use was 77 (52-95) days, and it is still ongoing at the time of publication of this article for 4 patients.Median (IQR) daily monitoring time was 23.5 (22.4-23.8)hours.No deaths were reported during the WCD use.The results of the WCD monitoring are shown in Supplementary material, Figure S1.During monitoring, sustained VTs (sVTs) were observed in 2 patients.In 2 other patients, nonsustained VTs (nsVT) were registered (Supplementary material, Figure S2A and S2B).No therapy was delivered for the abovementioned ventricular arrhythmias, as the patients deferred the therapy due to good tolerance of arrhythmia.Patients and methods A retrospective, single--center study included all consecutive patients (n = 18) who received WCD (LifeVest, ZOLL, Pittsburgh, United States) therapy from February 1, 2020 to September 30, 2023, in the Department of Cardiology and Electrotherapy, Medical University of Gdansk.The analysis included demographic data, comorbidities, pharmacologic treatment, and data on the use of WCD from the manufacturer's information technology system.The Bioethics Committee for Scientific Research at the Medical University of Gdansk bioethics committee approved the study (KB/616/2023). Statistical analysisA P value below 0.05 was assumed significant for all comparisons and calculations.Numerical variables were expressed
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Kempa et al. (2024) conducted an observational in Risk of sudden cardiac death (n=18). Wearable cardioverter-defibrillator (WCD) was evaluated on Avoidance of permanent ICD implantation. In a cohort of 18 patients at risk of sudden cardiac death, wearable cardioverter-defibrillator use was safe and well-tolerated, allowing 50% of patients with completed monitoring to avoid permanent ICD implantation.
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