Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome, Italy
Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
Open Heart. 2024 Sep 18;11(2):e002787. doi: 10.1136/openhrt-2024-002787.
Wearable cardioverter-defibrillators (WCD) have emerged as a valuable tool in the management of patients at risk for life-threatening arrhythmias. These devices offer a non-invasive and temporary solution, providing continuous monitoring and the potential for prompt defibrillation when needed. In this study, we explore the use of WCD and evaluate arrhythmic events through comprehensive monitoring.
From November 2022 to May 2024, we conducted an outpatient follow-up of 41 patients receiving WCD. Regular check-ups, remote monitoring and comprehensive echocardiography were performed to optimise a tailored therapy.
The average age of the patients was 59.2.4±16.5 years, with 78% being male. Among the cohort, 54% had hypertension, 41% were smokers and 66% had dyslipidaemia, while 27% were diabetic. WCD was assigned according to the Italian Association of Hospital Cardiologists position paper focussing on the appropriate use of WCD and European Society of Cardiology guidelines on ventricular arrhythmias and the prevention of sudden cardiac death: 24 (58%) patients had a de novo diagnosis of heart failure with reduced ejection fraction, 11 (27%) patients had a recent acute coronary syndrome and ejection fraction <35%, 3 (7%) patients had a cardiac electronic device extraction and 3 (7%) patients had myocarditis with features of electrical instability. The average follow-up was 62±38 days according to specific aetiology, with a daily wearing time of 22.7±1.3 hours. No device interventions were recorded. At the end of the follow-up period, 15 patients still required an implantable cardioverter-defibrillator (ICD). Among these, 12 patients (29%) underwent ICD implantation. Two patients (5%) declined the procedure.
The use of WCD for patients at high risk of arrhythmias allowed to optimise therapy and limit the indications for ICD. Inappropriate implantation of ICD was avoided in 69% of patients who received WCD. The device showed a good safety profile, low incidence of device interventions and adequate patients' adherence to WCD use.
可穿戴式除颤器（WCD）已成为管理有生命威胁性心律失常风险的患者的一种有价值的工具。这些设备提供了一种非侵入性和临时性的解决方案，可提供连续监测，并在需要时进行及时除颤。在这项研究中，我们探讨了 WCD 的使用，并通过全面监测评估心律失常事件。
2022 年 11 月至 2024 年 5 月，我们对 41 名接受 WCD 的门诊患者进行了随访。定期进行检查、远程监测和全面超声心动图检查，以优化个体化治疗。
患者的平均年龄为 59.2.4±16.5 岁，78%为男性。队列中有 54%的患者患有高血压，41%为吸烟者，66%有血脂异常，27%为糖尿病。WCD 的分配是根据意大利心脏病学会协会的位置文件，侧重于 WCD 的合理使用以及欧洲心脏病学会关于室性心律失常和预防心脏性猝死的指南：24（58%）例患者新诊断为射血分数降低的心力衰竭，11（27%）例患者近期发生急性冠状动脉综合征，射血分数<35%，3（7%）例患者心脏电子设备取出，3（7%）例患者心肌炎伴有电不稳定特征。根据具体病因，平均随访时间为 62±38 天，每天佩戴时间为 22.7±1.3 小时。未记录到设备干预。随访结束时，仍有 15 名患者需要植入式心律转复除颤器（ICD）。其中，12 例患者（29%）接受了 ICD 植入。2 例患者（5%）拒绝了该手术。
WCD 用于心律失常风险高的患者，可优化治疗并限制 ICD 的适应证。在接受 WCD 治疗的患者中，避免了 ICD 的不当植入，69%的患者避免了 ICD 的植入。该设备具有良好的安全性、低设备干预发生率和患者对 WCD 使用的充分依从性。
