Helms Thomas M, Müller A, Schwab J O, Bänsch D, Karle C, Klingenheben T, Zugck C, Perings C
Deutsche Stiftung für chronisch Kranke, Alexanderstraße 26, 90762, Fürth, Deutschland,
Herzschrittmacherther Elektrophysiol. 2015 Jun;26(2):129-33. doi: 10.1007/s00399-015-0365-7. Epub 2015 May 5.
While the implantable cardioverter-defibrillator (ICD) has been proven to be the best choice for patients with long-term risk for sudden cardiac arrest/sudden cardiac death (SCA/SCD), the question is how to manage patients with only temporary risk, e.g., during the guidelines-recommended waiting period until the decision for an ICD can be made. These patient groups should be monitored around the clock to guarantee a lifesaving shock within a few minutes, if necessary.These conditions can be accomplished by the wearable cardioverter-defibrillator (WCD) in the outpatient sector. The WCD is worn on the skin and consists of four nonadhesive ECG electrodes as well as three defibrillation electrodes-two at the back and one at the front-embedded in a garment. The defibrillation unit is connected via a cord and can be worn over the shoulder or on a belt. Cardiac events can be recorded and retrospectively analyzed by the treating physician.The WCD is a safe and effective measure to terminate potentially lethal ventricular tachycardia and ventricular fibrillation. It may be used early after myocardial infarction with reduced left ventricular ejection fraction (LVEF), as well as for patients with acute heart failure in nonischemic cardiomyopathy with uncertain cause and prognosis. In addition, it may be used for patients waiting for heart transplantation, for patients who cannot be implanted an ICD due to comorbidities, and for patients after explantation of their ICD, e.g., because of infection until reimplantation.One may expect that risk stratification of patients with the WCD will lead to even better selection for ICD use.
虽然植入式心脏复律除颤器（ICD）已被证明是有心脏骤停/心源性猝死（SCA/SCD）长期风险患者的最佳选择，但问题是如何管理仅具有临时风险的患者，例如在指南推荐的等待期内，直到可以做出植入ICD的决定。这些患者群体应进行全天候监测，以确保在必要时能在几分钟内给予救命电击。在门诊环境中，可穿戴式心脏复律除颤器（WCD）可以满足这些条件。WCD穿戴在皮肤上，由四个非粘性心电图电极以及三个除颤电极组成，其中两个在背部，一个在前部，嵌入一件衣服中。除颤单元通过一根电线连接，可以挂在肩上或系在腰带上。治疗医生可以记录心脏事件并进行回顾性分析。WCD是终止潜在致命性室性心动过速和心室颤动的一种安全有效的措施。它可在心肌梗死后左心室射血分数（LVEF）降低的早期使用，也可用于病因和预后不明的非缺血性心肌病急性心力衰竭患者。此外，它还可用于等待心脏移植的患者、因合并症无法植入ICD的患者以及ICD取出后（例如因感染直到重新植入）的患者。人们可能期望对使用WCD的患者进行风险分层将导致ICD使用的选择更加优化。
