Real life experience with the wearable cardioverter-defibrillator in an international multicenter Registry

Abstract

Patients at high risk for sudden cardiac death (SCD) may benefit from wearable cardioverter defibrillators (WCD) by avoiding immediate implantable cardioverter defibrillator (ICD) implantation. Different factors play an important role including patient selection, compliance and optimal drug treatment. We aimed to present real world data from 4 centers from Germany and Switzerland. Between 04/2012 and 03/2019, 708 patients were included in this registry. Patients were followed up over a mean time of 28 ± 35.5 months. Outcome data including gender differences and different etiologies of cardiomyopathy were analyzed. Out of 708 patients (81.8% males, mean age 61.0 ± 14.6), 44.6% of patients had non-ischemic cardiomyopathy, 39.8% ischemic cardiomyopathy, 7.9% myocarditis, 5.4% prior need for ICD explantation and 2.1% channelopathy. The mean wear time of WCD was 21.2 ± 4.3 h per day. In 46% of patients, left ventricular ejection fraction (LVEF) was > 35% during follow-up. The younger the patient was, the higher the LVEF and the lower the wear hours per day were. The total shock rate during follow-up was 2.7%. Whereas an appropriate WCD shock was documented in 16 patients (2.2%), 3 patients received an inappropriate ICD shock (0.5%). During follow-up, implantation of a cardiac implantable electronic device was carried out in 34.5% of patients. When comparing German patients (n = 516) to Swiss patients (n = 192), Swiss patients presented with longer wear days (70.72 ± 49.47 days versus 58.06 ± 40.45 days; p = 0.001) and a higher ICD implantation rate compared to German patients (48.4% versus 29.3%; p = 0.001), although LVEF at follow-up was similar between both groups. Young age is a negative independent predictor for the compliance in this large registry. The most common indication for WCD was non-ischemic cardiomyopathy followed by ischemic cardiomyopathy. The compliance rate was generally high with a decrease of wear hours per day at younger age. Slight differences were found between Swiss and German patients, which might be related to differences in mentality for ICD implantation.

Sex differences and adherence of patients treated with wearable cardioverter‐defibrillator: Insights from an international multicenter register

“…In our tertile age analysis, adherence was observed more in 73–91 years old group as compared to 14–51 years old group. In this regard, the WEARIT‐France study and another study showed that younger age was associated with a lower compliance 22,23 . However, our data showed that adherence with WCD use was not sex specific.…”

“…In this regard, the WEARIT-France study and another study showed that younger age was associated with a lower compliance. 22,23 However, our data showed that adherence with WCD use was not sex specific.…”

Effect of sacubitril/valsartan on the occurrence of cardiac arrhythmias and the risk of sudden cardiac death in heart failure: A meta-analysis of randomized controlled trials

“…In most cases, SCD is triggered by ventricular arrhythmias ( 38 ). Implantable cardioverter defibrillator (ICD) and wearable cardioverter defibrillator (WCD) are recommended for the prevention of SCD in selected populations ( 39 , 40 ). Our meta-analysis showed that there was a 21% reduction in the risk of SCD.…”

Age differences of patients treated with wearable cardioverter defibrillator: Data from a multicentre registry

“…Several publications reported that by using a wearable cardioverter defibrillator (WCD), a permanent ICD could be avoided in a significant part of patients 4–6 . The Vest trial investigated the benefit of WCD in 1524 patients, who suffered a myocardial infarction and developed a reduced LVEF; 778 patients were randomized for a WCD, and 746 patients did not receive a WCD.…”

“…3 Several publications reported that by using a wearable cardioverter defibrillator (WCD), a permanent ICD could be avoided in a significant part of patients. [4][5][6] The Vest trial investigated the benefit of WCD in 1524 patients, who suffered a myocardial infarction and developed a reduced LVEF; 778 patients were randomized for a WCD, and 746 patients did not receive a WCD. Despite treatment with WCD, the arrhythmic death was not significantly different (1.6% vs. 2.8%, p = .18), however, the all-cause mortality was significantly reduced (3.1% vs. 4.9%, p = .04).…”