Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Department of Cardiology, Faculty of Medicine, University of Tsukuba.
Circ J. 2018 May 25;82(6):1481-1486. doi: 10.1253/circj.CJ-17-1336. Epub 2018 Feb 14.
Prevention of sudden cardiac death (SCD) has become an important issue in today's cardiovascular field, together with various developments in secondary prevention of basic cardiac diseases. The importance of the implantable cardioverter defibrillator (ICD) is now widely accepted because it has exhibited significant improvement in patients' prognoses in ischemic and non-ischemic cardiovascular diseases. However, there is an unignorable gap between the ICD indication in the guidelines and real-world high-risk patients for SCD, especially in the acute recovery phase of cardiac injury. Although various studies have demonstrated a clinical benefit of defibrillation devices, the studies of immediate ICD use in the acute recovery phase have failed to exhibit a benefit in patients from the point of the view of a decrease in total deaths. To bridge this gap, the wearable cardioverter defibrillator (WCD) provides a safer observation period in the acute phase and eliminates inappropriate overuse of ICD in the subacute phase. Here, we discuss the usefulness of the WCD and current understanding of its indications based on various clinical data. In conclusion, WCD is a feasible bridge to therapy and/or safe observation for patients at high risk of SCD, especially in the acute recovery phase of cardiac diseases.
预防心源性猝死（SCD）已成为当今心血管领域的重要问题，同时也伴随着基础心脏疾病二级预防的各种进展。植入式心律转复除颤器（ICD）的重要性现在已被广泛接受，因为它在缺血性和非缺血性心血管疾病患者的预后方面表现出了显著的改善。然而，指南中的 ICD 适应证与 SCD 的实际高危患者之间存在不可忽视的差距，特别是在心脏损伤的急性恢复期。尽管多项研究表明除颤设备具有临床益处，但从总死亡率降低的角度来看，在急性恢复期立即使用 ICD 的研究并未显示出对患者的益处。为了弥合这一差距，可穿戴式除颤器（WCD）在急性阶段提供了更安全的观察期，并消除了亚急性阶段 ICD 的不适当过度使用。在这里，我们根据各种临床数据讨论了 WCD 的有用性及其适应证的现有认识。总之，WCD 是 SCD 高危患者的一种可行的治疗和/或安全观察桥梁，特别是在心脏疾病的急性恢复期。
