Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
JACC Clin Electrophysiol. 2018 Feb;4(2):231-239. doi: 10.1016/j.jacep.2017.09.180. Epub 2017 Nov 15.
This study sought to characterize the experience in a cohort of patients prescribed a wearable cardioverter-defibrillator (WCD) over a 2-year interval at 2 academic medical centers.
The WCD is available for patients felt to be at high risk of sudden cardiac death. However, there is a lack of randomized data to guide its use and prescribing patterns vary.
We retrospectively reviewed indications and therapies of all WCD prescriptions over a 2-year period from 2 large academic medical centers. Data on compliance and treatment events of patients wearing the WCD were reviewed.
Among the 147 patients prescribed a WCD, 80% were male with an age of 59 ± 14 years. The WCD was prescribed for the following reasons: primary prevention in the setting of a left ventricular ejection fraction ≤35% (53%), secondary prevention when an implantable cardioverter-defibrillator was not implanted (16%), implantable cardioverter-defibrillator explantation (23%), and other high-risk scenarios for arrhythmic sudden death (9%). The median wear duration was 50 days (interquartile range [IQR]: 25 to 85 days) with a median of 21.0 h of wear per day (IQR: 15.0 to 22.8 h). High-voltage treatment was delivered in 3 separate patients, 2 of whom died. The third patient received 3 WCD shocks without restoration of a perfusing rhythm and ultimately was resuscitated by emergency responders. No patients received inappropriate therapies.
Events requiring therapy were rare and no lives were directly saved by the WCD. Future efforts are needed to improve identification of patients most likely to benefit from a WCD.
本研究旨在描述在 2 所学术医疗中心，在 2 年期间内，一组佩戴体外除颤器（WCD）的患者的经历。
WCD 可用于被认为有发生心源性猝死高风险的患者。然而，目前缺乏指导其使用的随机数据，其处方模式也存在差异。
我们回顾了 2 所大型学术医疗中心在 2 年内所有 WCD 处方的适应证和治疗方法。对佩戴 WCD 的患者的依从性和治疗事件的数据进行了审查。
在 147 名被处方 WCD 的患者中，80%为男性，年龄为 59 ± 14 岁。WCD 的处方适应证如下：左心室射血分数≤35%时的一级预防（53%）、未植入植入式心律转复除颤器时的二级预防（16%）、植入式心律转复除颤器的移除（23%）和其他心律失常性猝死高危情况（9%）。中位佩戴时间为 50 天（四分位间距[IQR]：25 至 85 天），中位每日佩戴时间为 21.0 小时（IQR：15.0 至 22.8 小时）。有 3 名患者接受了高压治疗，其中 2 人死亡。第 3 名患者接受了 3 次 WCD 电击，但未恢复灌注节律，最终被急救人员复苏。没有患者接受不适当的治疗。
需要治疗的事件很少见，WCD 并没有直接挽救生命。需要进一步努力以提高识别最有可能从 WCD 中获益的患者的能力。
