Röger Susanne, Rosenkaimer Stefanie L, Hohneck Anna, Lang Siegfried, El-Battrawy Ibrahim, Rudic Boris, Tülümen Erol, Stach Ksenija, Kuschyk Jürgen, Akin Ibrahim, Borggrefe Martin
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
BMC Cardiovasc Disord. 2018 Mar 15;18(1):52. doi: 10.1186/s12872-018-0790-8.
The wearable cardioverter-defibrillator (WCD) has emerged as a valuable tool to temporarily protect patients at risk for sudden cardiac death (SCD). The aim of this study was to determine the value of the WCD for therapy optimization of heart failure patients.
One hundred five consecutive patients that received WCD between 4/2012 and 9/2016 were included in the study. All patients were followed for clinical outcome and echocardiographic parameters during WCD therapy and had continued follow-up after WCD therapy, irrespective of subsequent implantable cardioverter-defibrillator (ICD) implantation.
The most common indication for WCD were newly diagnosed ischemic (ICM) or non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction (LVEF) ≤35%. Mean WCD wear time was 68.8 ± 50.4 days with a mean daily use of 21.5 ± 3.5 h. Five patients (4.8%) received a total of five appropriate WCD shocks. During WCD wear, patients with ICM and NICM showed significant improvement in LVEF, reducing the proportion of patients with a need for primary preventive ICD implantation to 54.8% (ICM) and 48.8% (NICM). An ICD was finally implanted in 51.4% of the study patients (24 trans-venous ICDs, 30 subcutaneous ICDs). After discontinuation of WCD therapy, all patients were followed for a mean of 18.6 ± 12.3 months. 5.6% of patients with implanted ICDs received appropriate therapies. No patient with subcutaneous ICD needed change to a trans-venous device. None of the patients without an implanted ICD suffered from ventricular tachyarrhythmias and no patient died suddenly. In patients with NICM a significant LVEF improvement was observed during long-term follow-up (from 34.8 ± 11.1% to 41.0 ± 10.2%).
WCD therapy successfully bridged all patients to either LVEF recovery or ICD implantation. Following WCD, ICD implantation could be avoided in almost half of the patients. In selected patients, prolongation of WCD therapy beyond 3 months might further prevent unnecessary ICD implantation. The WCD as an external monitoring system contributed important information to optimize device selection in patients that needed ICD implantation.
可穿戴式心脏复律除颤器（WCD）已成为暂时保护有心脏性猝死（SCD）风险患者的一项重要工具。本研究的目的是确定WCD对心力衰竭患者治疗优化的价值。
本研究纳入了2012年4月至2016年9月期间连续105例接受WCD治疗的患者。所有患者在WCD治疗期间均接受临床结局和超声心动图参数随访，且在WCD治疗后持续随访，无论随后是否植入植入式心脏复律除颤器（ICD）。
WCD最常见的适应证是新诊断的缺血性（ICM）或非缺血性心肌病（NICM）且左心室射血分数（LVEF）≤35%。WCD平均佩戴时间为68.8±50.4天，平均每日使用时间为21.5±3.5小时。5例患者（4.8%）共接受了5次适当的WCD电击。在佩戴WCD期间，ICM和NICM患者的LVEF有显著改善，将需要植入一级预防ICD的患者比例降至54.8%（ICM）和48.8%（NICM）。最终，51.4%的研究患者植入了ICD（24例经静脉ICD，30例皮下ICD）。停止WCD治疗后，所有患者平均随访18.6±12.3个月。5.6%植入ICD的患者接受了适当治疗。没有皮下ICD患者需要更换为经静脉装置。没有植入ICD的患者发生室性快速心律失常，也没有患者突然死亡。在NICM患者的长期随访中观察到LVEF有显著改善（从34.8±11.1%提高到41.0±10.2%）。
WCD治疗成功地使所有患者过渡到LVEF恢复或ICD植入。使用WCD后，几乎一半的患者可以避免植入ICD。在选定的患者中，将WCD治疗延长超过3个月可能进一步预防不必要的ICD植入。WCD作为一种外部监测系统，为优化需要植入ICD患者的设备选择提供了重要信息。
