Naniwadekar Aditi, Alnabelsi Talal, Joshi Kamal, Obasare Edinrin, Greenspan Allan, Mainigi Sumeet
The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States.
Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, United States.
Indian Pacing Electrophysiol J. 2017 May-Jun;17(3):65-69. doi: 10.1016/j.ipej.2017.01.003. Epub 2017 Jan 9.
The wearable cardioverter-defibrillator (WCD) is used in patients at risk for sudden cardiac death (SCD) but not immediate candidates for intracardiac defibrillator (ICD) implantation.
We performed a single center retrospective study of patients prescribed WCD upon hospital discharge from January 2002 to October 2015. Clinical characteristics were obtained from the hospital electronic database and device data from Zoll LifeVest database.
Of 140 patients, 62% were men, 85.9% were African-American and mean age was 58.2 ± 15.5 years. Ischemic cardiomyopathy was present in 45 (32%) and non-ischemic cardiomyopathy in 64 patients (46%). Mean left ventricular ejection fraction (EF) was 0.28 ± 0.4. WCD was worn for 7657 patient-days (21 patient-years), with each patient using WCD for median of 43 days (IQR: 7-83 days), and daily mean use 17.3 ± 7.5 h. There were a total of 6 (4.2%) WCD shocks of which 2 (1.4%) were appropriate (one for VT, one for VF) and 4 (2.8%) were inappropriate (2 had supraventricular tachycardia, 2 had artifact). Two patients who received appropriate shocks were African-American with non-ischemic cardiomyopathy (EF<20%), non-sustained VT and wide QRS duration. Upon termination of WCD use, 45 (32%) received ICD while EF improved in 34 patients (32%).
In a predominantly minority, community setting, WCD compliance is high and use is effective in aborting SCD. However, inappropriate shocks do occur. A significant proportion of patients did not ultimately require ICD implantation suggesting this may be a cost-effective strategy in patients at risk of SCD.
可穿戴式心脏复律除颤器（WCD）用于有心脏性猝死（SCD）风险但并非立即适合植入心内除颤器（ICD）的患者。
我们对2002年1月至2015年10月出院时开具WCD处方的患者进行了单中心回顾性研究。临床特征从医院电子数据库中获取，设备数据来自Zoll LifeVest数据库。
140例患者中，62%为男性，85.9%为非裔美国人，平均年龄为58.2±15.5岁。45例（32%）存在缺血性心肌病，64例（46%）存在非缺血性心肌病。平均左心室射血分数（EF）为0.28±0.4。WCD佩戴时间为7657患者日（21患者年），每位患者使用WCD的中位时间为43天（四分位间距：7 - 83天），每日平均使用时间为17.3±7.5小时。共有6次（4.2%）WCD电击，其中2次（1.4%）为恰当电击（1次针对室性心动过速，1次针对心室颤动），4次（2.8%）为不恰当电击（2次为室上性心动过速，2次为伪差）。2例接受恰当电击的患者为非裔美国人，患有非缺血性心肌病（EF<20%）、非持续性室性心动过速且QRS波时限增宽。在停止使用WCD后，45例（32%）接受了ICD植入，34例患者（32%）的EF有所改善。
在以少数族裔为主的社区环境中，WCD的依从性较高，且在预防SCD方面使用有效。然而，确实会发生不恰当电击。相当一部分患者最终并未需要植入ICD，这表明对于有SCD风险的患者而言，这可能是一种具有成本效益的策略。
