Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York.
Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York.
Heart Rhythm. 2018 Sep;15(9):1379-1386. doi: 10.1016/j.hrthm.2018.04.014. Epub 2018 Apr 18.
Use of the wearable cardioverter-defibrillator (WCD) in older patients has not been described previously.
The purpose of this study was to assess WCD wear time, risk of arrhythmic events during WCD use, and implantable cardioverter-defibrillator (ICD) implantation rates after the end of WCD use in patients with age ≥65 years vs <65 years.
We stratified 1732 patients with ischemic and nonischemic cardiomyopathy from the Prospective Registry of Patients Using the Wearable Defibrillator Registry into 2 subgroups by age: those with age ≥65 years and those with age <65 years. Wear time, arrhythmic events, and end-of-use decisions, specifically ICD implantation or improvement in ejection fraction, were evaluated for each age group.
There were 722 patients with age ≥65 years (41.7%) and 1010 patients with age <65 years (58.3%). Daily WCD wear time was longer in the older population (median 22.8 h/d (IQR 21.5 - 23.2) vs 22.3 h/d (IQR 19.5 - 23.0); P < .001). Patients with age ≥65 years experienced higher event rates, per 100 patient-years, for any sustained ventricular tachycardia/ventricular fibrillation (31.95 vs 9.82; P = .027) and ventricular tachycardia/ventricular fibrillation treated with WCD shock (6.92 vs 2.37; P = .034), particularly with ischemic cardiomyopathy. Younger patients experienced a trend toward a higher event rate for atrial arrhythmias with nonischemic cardiomyopathy (150.07 vs 74.86; P = .055). At the end of WCD use, ICD implantation was more frequent in older patients (41.8% vs 36.5%; P = .034).
Older patients had good compliance with the WCD, presented with more frequent ventricular arrhythmias, and were more likely to receive an ICD at the end of WCD use. The WCD may play a role in risk stratification of the older population.
此前尚未有研究描述过可穿戴式除颤器（WCD）在老年患者中的应用。
本研究旨在评估年龄≥65 岁与<65 岁患者使用 WCD 的时间、WCD 使用期间心律失常事件的风险，以及 WCD 停用后的植入式心脏复律除颤器（ICD）植入率。
我们将 1732 例缺血性和非缺血性心肌病患者前瞻性登记入组，根据年龄分为 2 个亚组：年龄≥65 岁和年龄<65 岁。评估了每个年龄组的佩戴时间、心律失常事件以及 WCD 使用结束时的决策，具体为 ICD 植入或射血分数改善。
年龄≥65 岁患者 722 例（41.7%），年龄<65 岁患者 1010 例（58.3%）。老年人群的 WCD 日佩戴时间更长（中位数 22.8 h/d（IQR 21.5-23.2）比 22.3 h/d（IQR 19.5-23.0）；P<0.001）。年龄≥65 岁患者每 100 患者年因任何持续性室性心动过速/心室颤动（31.95 比 9.82；P=0.027）和 WCD 电击治疗的室性心动过速/心室颤动（6.92 比 2.37；P=0.034）的事件发生率更高，尤其是缺血性心肌病患者。非缺血性心肌病患者中，年轻患者的房性心律失常发生率呈增高趋势（150.07 比 74.86；P=0.055）。WCD 使用结束时，老年患者更倾向于植入 ICD（41.8%比 36.5%；P=0.034）。
老年患者对 WCD 有较好的依从性，出现更频繁的室性心律失常，且在 WCD 使用结束时更倾向于植入 ICD。WCD 可能在老年人群的风险分层中发挥作用。
