Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA.
Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.
Curr Cardiol Rep. 2019 Sep 7;21(10):125. doi: 10.1007/s11886-019-1215-8.
To discuss the role of wearable cardioverter defibrillator (WCD) vests in preventing sudden cardiac death (SCD) in at-risk populations.
The impact of randomized-controlled trials with implantable cardioverter-defibrillators (ICD) therapy is well established in randomized clinical trials in ischemic cardiomyopathy. Although the benefits are not as clear in non-ischemic cardiomyopathy, meta-analyses show significant mortality benefits from immediate electrical cardioversion strategies. The role of WCDs in at-risk populations in whom ICD therapy is temporarily not indicated is not as well-established. Smaller cohort trials have shown efficacy in patients with newly-diagnosed cardiomyopathy, requiring temporary ICD explantation, and others with less common indications for WCD therapy. The Vest Prevention of Early Sudden Death Trial was a landmark randomized control study seeking to examine the benefits of WCD therapy in at-risk population, and although the primary endpoint of reducing arrhythmic death was not reached, the structure of the trial and significant differences in total mortality make a compelling case for continued use of WCD therapies in our healthcare systems.
讨论可穿戴式除颤器（WCD）背心在高危人群中预防心源性猝死（SCD）的作用。
在缺血性心肌病的随机临床试验中，植入式心脏复律除颤器（ICD）治疗的随机对照试验的影响已得到充分证实。尽管在非缺血性心肌病中其益处并不明显，但荟萃分析显示，立即进行电复律策略可显著降低死亡率。在 ICD 治疗暂时不适用的高危人群中，WCD 的作用尚未得到充分证实。较小的队列试验已经证明了在新诊断的心肌病患者、需要暂时取出 ICD 的患者以及其他 WCD 治疗适应证较少的患者中，WCD 治疗具有疗效。Vest 预防早期猝死试验是一项具有里程碑意义的随机对照研究，旨在研究 WCD 治疗在高危人群中的益处，尽管降低心律失常性死亡的主要终点未达到，但试验结构和总死亡率的显著差异为在我们的医疗保健系统中继续使用 WCD 治疗提供了有力依据。
