Bhaskaran Abhishek, Bartlett Monique, Kovoor Pramesh, Davis Lloyd M
Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.
Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.
Heart Lung Circ. 2016 Feb;25(2):155-9. doi: 10.1016/j.hlc.2015.07.011. Epub 2015 Aug 4.
Wearable Cardioverter Defibrillators (WCD) have been effectively used for more than a decade in North America and Europe for prevention of sudden cardiac death (SCD) due to ventricular arrhythmias. This device has only recently been available in Australia.
At Westmead hospital, WCD has been used since 2013 as a bridging therapy to an implantable cardioverter defibrillator (ICD) for those at high risk, but are temporarily not suitable for an implantable device. Indications for use were explanted infected ICD, dilated cardiomyopathy, post partum cardiomyopathy, valvular heart disease and myocarditis. The default device settings were: ventricular tachycardia (VT) and ventricular fibrillation (VF) threshold of 150 bpm and 200 bpm respectively and response times were 60 secs for VT and 25 secs for VF.
WCD was used in eight patients. Duration of use ranged from five to 180 days with median of 77 days. Daily usage averaged 23.4±0.6hours. All except one were compliant with the device and none of our patients received shock or died during device usage. Four of the eight patients received ICD, two declined ICD, one was judged to no longer require ICD and one remains under assessment.
WCD is easy to use, well tolerated and is effective for SCD prevention in patients who are temporarily not suitable for ICD. However patients need to be actively followed-up to reduce the duration of WCD usage and thereby be cost effective.
可穿戴式心脏复律除颤器（WCD）在北美和欧洲已有效使用超过十年，用于预防室性心律失常导致的心脏性猝死（SCD）。该设备直到最近才在澳大利亚上市。
自2013年以来，韦斯特米德医院一直将WCD用作高风险但暂时不适合植入式设备的患者植入式心脏复律除颤器（ICD）的过渡治疗。使用指征包括取出感染的ICD、扩张型心肌病、产后心肌病、瓣膜性心脏病和心肌炎。默认设备设置为：室性心动过速（VT）和室性颤动（VF）阈值分别为150次/分钟和200次/分钟，VT的响应时间为60秒，VF的响应时间为25秒。
八名患者使用了WCD。使用时间为5至180天，中位数为77天。每日平均使用时间为23.4±0.6小时。除一人外，所有患者均能配合使用该设备，且在设备使用期间，我们的患者均未接受电击或死亡。八名患者中有四名接受了ICD，两名拒绝接受ICD，一名被判定不再需要ICD，一名仍在评估中。
WCD易于使用，耐受性良好，对暂时不适合ICD的患者预防SCD有效。然而，需要积极随访患者，以缩短WCD的使用时间，从而提高成本效益。
