Protection from Outpatient Sudden Cardiac Death following ICD Removal Using a Wearable Cardioverter Defibrillator

Tanawuttiwat, Tanyanan; Garisto, Juan; Salow, Arturo D.; Glad, Joann M.; Szymkiewicz, Steve; Saltzman, Heath; Kutalek, Steven P.; Carrillo, Roger G.

doi:10.1111/pace.12319

Cited by 34 publications

(30 citation statements)

References 24 publications

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“…Wearable cardioverter‐defibrillator (WCD) is an external device that monitors health rhythm continuously and delivers an electric shock when ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) is detected. A clinical study showed promising findings that the WCD prevented SCD in patients with temporary ICD removal . Data from the Prospective Registry of Patient Using the Wearable Defibrillator (WEARIT‐II) Registry demonstrated a high rate (3% for 3 months) of sustained ventricular tachyarrhythmia at high‐risk patients, and suggested WCD to be safe and effective in protecting patients at risk of SCA .…”

Section: Introductionmentioning

confidence: 99%

Potential cost‐effectiveness of wearable cardioverter‐defibrillator for patients with implantable cardioverter‐defibrillator explant in a high‐income city of China

Jiang

Ming

You

2019

Cardiovasc electrophysiol

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Introduction Wearable cardioverter‐defibrillator (WCD) is recommended for patients with implantable cardioverter‐defibrillator (ICD) removal. This study aimed to investigate the potential cost‐effectiveness of WCD for patients with ICD explant in a high‐income city of China. Methods and Results A 5‐year decision‐analytic model was developed to simulate outcomes of three strategies during the period between ICD explant and reimplantation: discharge‐to‐home without WCD (home group), discharge‐to‐home with WCD (WCD group), and stay‐in‐hospital (hospital group). Outcome measures were mortality rates (during the period between ICD explant and reimplantation), direct medical costs, quality‐adjusted life years (QALYs), and incremental cost per QALY saved (ICER). Model inputs were derived from literature and public data. Base‐case analysis was performed at four cost levels of WCD. Robustness of model results was examined by sensitivity analyses. In base‐case analysis, the 8‐week mortality rates of WCD, hospital, and home groups were 7.3%, 8.1%, and 9.4%, respectively. WCD group gained the highest QALYs (3.0990 QALYs), followed by hospital group (3.0553 QALYs) and home group (3.0132 QALYs). The WCD group was the cost‐effective option with ICERs less than willingness‐to‐pay (WTP) threshold (57 315 USD/QALY) at WCD daily cost ≤USD48. In probabilistic sensitivity analysis, the WCD group at daily cost of USD24, USD48, USD72, and USD96 were cost‐effective in 100%, 94.16%, 22.08%, and 0.16% of 10 000 Monte Carlo simulations, respectively. Conclusions Use of WCD during the period between ICD explant and reimplantation is likely to save life and gain higher QALYs. Cost‐effectiveness of WCD is highly subject to the daily cost of WCD in China.

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Section: Introductionmentioning

confidence: 99%

Potential cost‐effectiveness of wearable cardioverter‐defibrillator for patients with implantable cardioverter‐defibrillator explant in a high‐income city of China

Jiang

Ming

You

2019

Cardiovasc electrophysiol

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“…Lack of compliance might have dramatics consequences. Indeed, in various studies, the majority of SCD observed during follow-up were observed in patients not or not-correctly wearing the WCD[7,8]. Weight and footprint of the device were the main reasons for low compliance.…”

Section: Patient Education and Compliancementioning

confidence: 99%

“…Period before re-implantation is long, so that patients could beneficiate from WCD protection without deleting hospital discharge, as the risk of SCD remains unchanged[7] during this period. Highest incidence rate of appropriate therapies remains to patients after ICD explantation for infection in expectation of reimplantation compared with other indications[14].…”

Section: Clinical Studiesmentioning

confidence: 99%

Wearable cardioverter defibrillator: Bridge or alternative to implantation?

Barraud¹,

Cautela²,

Orabona³

et al. 2017

WJC

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The implantable cardioverter-defibrillator (ICD) is effective to prevent sudden cardiac death (SCD) in selected patients with heart disease known to be at high risk for ventricular arrhythmia. Nevertheless, this invasive and definitive therapy is not indicated in patients with potentially transient or reversible causes of sudden death, or in patients with temporary contra-indication for ICD placement. The wearable cardioverter defibrillator (WCD) is increasingly used for SCD prevention both in patients awaiting ICD implantation or with an estimated high risk of ventricular arrhythmia though to be transient. We conducted a review of current clinical uses and benefits of the WCD, and described its technical aspects, limitations and perspectives.

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“…Recent trials demonstrated the efficacy of the WCD in the detection and treatment of lethal ventricular arrhythmias [57], [61]. The WCD therapy can prevent SCD until ICD re-implantation is feasible in patients who underwent device removals for device system infections [62].…”

Section: New Technology To Reduce the Risk Of Sudden Cardiac Death Afmentioning

confidence: 99%

New horizon for infection prevention technology and implantable device

Kondo

Ueda

Kobayashi

et al. 2016

Journal of Arrhythmia

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There has been a significant increase in the number of patients receiving cardiovascular implantable electronic devices (CIED) over the last two decades. CIED infection represents a serious complication after CIED implantation and is associated with significant morbidity and mortality. Recently, newly advanced technologies have offered attractive and suitable therapeutic alternatives. Notably, the leadless pacemaker and anti-bacterial envelope decrease the potential risk of CIED infection and the resulting mortality, when it does occur. A completely subcutaneous implantable cardioverter defibrillator is also an alternative to the transvenous implantable cardioverter defibrillator (ICD), as it does not require implantation of any transvenous or epicardial leads. Among the patients who require ICD removal and subsequent antibiotics secondary to infection, the wearable cardioverter defibrillator represents an alternative approach to inpatient monitoring for the prevention of sudden cardiac death. In this review paper, we aimed to introduce the advanced technologies and devices for prevention of CIED infection.

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Protection from Outpatient Sudden Cardiac Death following ICD Removal Using a Wearable Cardioverter Defibrillator

Abstract: WCD can prevent SCD, until ICD reimplantation is feasible in patients who underwent device removals for CDI. However, patient compliance is essential for the effective use of this device.

Cited by 34 publications

References 24 publications

Potential cost‐effectiveness of wearable cardioverter‐defibrillator for patients with implantable cardioverter‐defibrillator explant in a high‐income city of China

Potential cost‐effectiveness of wearable cardioverter‐defibrillator for patients with implantable cardioverter‐defibrillator explant in a high‐income city of China

Wearable cardioverter defibrillator: Bridge or alternative to implantation?

New horizon for infection prevention technology and implantable device

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