University of Rochester Medical Center, Heart Research Follow-up Program, Box 653, 265 Crittenden Blvd. Rochester, NY 14620, USA.
Eur Heart J. 2013 Aug;34(29):2230-42. doi: 10.1093/eurheartj/eht167. Epub 2013 May 31.
The benefit of implantable cardioverter-defibrillator (ICD) therapy depends upon appropriate evaluation of a persisting risk of sudden death and estimation of the patient's overall survival. Assessment of a stable and unchangeable arrhythmogenic substrate is often difficult. Structural abnormality and ventricular dysfunction, the two major risk parameters, may recover, and heart failure symptoms can improve so that ICD therapy may not be indicated. Risk stratification can take time while the patient continues to be at high risk of arrhythmic death, and patients may need temporary bridging by a defibrillator in cases of interrupted ICD therapy. The wearable cardioverter-defibrillator (WCD) combines a long-term electrocardiogram (ECG)-monitoring system with an external automatic defibrillator. The LIfeVest® (ZOLL, Pittsburgh, PA, USA) is composed of a garment, containing two defibrillation patch electrodes on the back, and an elastic belt with a front-defibrillation patch electrode and four non-adhesive ECG electrodes, connected to a monitoring and defibrillation unit. The WCD is a safe and effective tool to terminate ventricular tachycardia/ventricular fibrillation events, unless a conscious patient withholds shock delivery. It may be used in patients in the early phase after acute myocardial infarction with poor left ventricular function, after acute coronary revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) and reduced left ventricular ejection fraction (≤35%), in patients with acute heart failure in non-ischaemic cardiomyopathy of uncertain aetiology and prognosis. The WCD may be helpful in subjects with syncope of assumed tachyarrhythmia origin or in patients with inherited arrhythmia syndromes. The WCD may replace ICD implantation in patients waiting for heart transplantation or who need a ventricular-assist device. This review describes the technical details and characteristics of the WCD, discusses its various potential applications, and reports the currently available experience with the wearable defibrillator.
植入式心脏复律除颤器（ICD）治疗的益处取决于对持续性猝死风险的适当评估和对患者总体生存率的估计。稳定且不变的致心律失常基质的评估通常较为困难。结构异常和心室功能障碍，这两个主要的风险参数，可能会恢复，心力衰竭症状可能会改善，以至于可能不需要 ICD 治疗。风险分层可能需要时间，而患者仍然有发生心律失常性死亡的高风险，并且在 ICD 治疗中断的情况下，患者可能需要通过除颤器进行临时桥接。可穿戴式心脏除颤器（WCD）将长期心电图（ECG）监测系统与外部自动除颤器相结合。LifeVest®（ZOLL，匹兹堡，宾夕法尼亚州，美国）由一件衣服组成，背面有两个除颤贴片电极，一条弹性腰带，正面有一个除颤贴片电极和四个非粘性 ECG 电极，连接到监测和除颤单元。WCD 是一种安全有效的工具，可终止室性心动过速/心室颤动事件，除非有意识的患者拒绝进行电击。它可用于急性心肌梗死后左心室功能不良、急性冠状动脉血运重建术（经皮冠状动脉介入治疗或冠状动脉旁路移植术）和左心室射血分数降低（≤35%）后的患者、急性非缺血性心肌病心力衰竭患者，病因和预后不确定。WCD 可能对怀疑起源于心动过速的晕厥患者或遗传性心律失常综合征患者有帮助。WCD 可替代 ICD 植入，用于等待心脏移植或需要心室辅助装置的患者。这篇综述描述了 WCD 的技术细节和特点，讨论了其各种潜在应用，并报告了目前可用的可穿戴除颤器经验。
