Lamichhane Madhab, Gardiner Joseph C, Bianco Nicole R, Szymkiewicz Steven J, Thakur Ranjan K
Cardiovascular Disease Fellowship Program, Michigan State University/Sparrow Thoracic and Cardiovascular Institute, 1200 E Michigan Ave; Suite 580, East Lansing, MI, 48912, USA.
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
J Interv Card Electrophysiol. 2017 Jan;48(1):11-19. doi: 10.1007/s10840-016-0194-6. Epub 2016 Oct 17.
The wearable cardioverter defibrillator (WCD) is generally used for short periods of sudden cardiac death (SCD) risk; circumstances may occasionally result in prolonged use (over 1 year). The aim of this study was to determine the benefits and risks of prolonged use in patients with systolic heart failure (HF).
ZOLL's post-market US database included adult patients (≥18 years) with ischemic and/or non-ischemic cardiomyopathy (ICM, NICM) and at least 1 year of use. Cox-regression was used to identify factors associated with survival with WCD use, and reasons for stopping use were entered as time-dependent factors.
Among 220 patients, age (mean ± SD) 55.4 ± 14.8 years, WCD use 451.4 ± 289.9 days, and 67.3 % were male and their left ventricle ejection fraction (EF) averaged 20.9 ± 7.2 %. Eighty-nine (40.5 %) were continuing WCD use at the last follow-up. Thirty-six (16.4 %) and 56 (25.5 %) patients discontinued WCD use because of EF recovery and implantable cardioverter (ICD) implantation, respectively. Nine patients (4.1 %) received appropriate shock therapy for 13 episodes of sustained ventricular tachyarrhythmia with 12 (92.3 %) successful shocks. One patient died of refractory ventricular fibrillation. One patient died from sinus bradycardia transitioning to asystole. Eight patients (3.6 %) had nine episodes of non-fatal inappropriate shocks.
Long-term use of the WCD is safe and effective. Recovery of EF was seen in significant number of patients even after 1 year of WCD use.
可穿戴式心脏复律除颤器（WCD）通常用于短期存在心脏性猝死（SCD）风险的情况；但某些情况可能导致其长期使用（超过1年）。本研究的目的是确定在收缩性心力衰竭（HF）患者中延长使用WCD的益处和风险。
ZOLL公司的美国上市后数据库纳入了患有缺血性和/或非缺血性心肌病（ICM、NICM）且使用WCD至少1年的成年患者（≥18岁）。采用Cox回归分析确定与使用WCD生存相关的因素，并将停用原因作为时间依赖性因素纳入分析。
220例患者中，年龄（均值±标准差）为55.4±14.8岁，WCD使用时间为451.4±289.9天，67.3%为男性，左心室射血分数（EF）平均为20.9±7.2%。在最后一次随访时，89例（40.5%）患者仍在继续使用WCD。分别有36例（16.4%）和56例（25.5%）患者因EF恢复和植入式心脏复律除颤器（ICD）植入而停用WCD。9例患者（4.1%）因13次持续性室性快速心律失常接受了适当的电击治疗，其中12次（92.3%）电击成功。1例患者死于难治性心室颤动。1例患者死于窦性心动过缓转变为心搏停止。8例患者（3.6%）发生了9次非致命性不适当电击。
WCD的长期使用是安全有效的。即使在使用WCD 1年后，仍有相当数量的患者出现EF恢复。
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