The wearable cardioverter-defibrillator: current technology and evolving indications

Reek, Sven; Burri, Haran; Roberts, Paul R.; Perings, Christian; Epstein, Andrew E.; Klein, Helmut U.

doi:10.1093/europace/euw180

Cited by 67 publications

(62 citation statements)

References 55 publications

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“…The present model consisted of an 8‐week decision tree model, followed by a 5‐year Markov model with yearly cycle. The first 8‐week period approximated the length of time (commonly for antibiotic therapy of infection) required before clinical conditions allowed ICD reimplantation . During the 8‐week period, patients in all three groups might or might not die of non‐SCA causes.…”

Section: Methodsmentioning

confidence: 99%

“…4 Three strategies for the period between ICD explant and reimplantation were examined in the present model ( week period approximated the length of time (commonly for antibiotic therapy of infection) required before clinical conditions allowed ICD reimplantation. 12 During the 8-week period, patients in all three groups might or might not die of non-SCA causes. Patients who did not die of non-SCA causes might experience an SCA event.…”

Section: Design and Settingmentioning

confidence: 99%

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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: Methodsmentioning

confidence: 99%

Section: Design and Settingmentioning

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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“…A noninvasive monitoring strategy such as CABs that can be shown to guide medical therapies in such a manner that rehospitalizations are reduced would provide significant value to patients and to the healthcare system. In such a case, addition of CAB measurements to WCDs would provide additional incentives for patients to comply with WCD use; it comes as no surprise that compliance with WCD is key to its ability to prevent sudden cardiac death (Olgin et al, ; Reek et al, ) and limits the potential benefit for some patients.…”

Section: Discussionmentioning

confidence: 99%

“…Wearable cardioverter defibrillators are prescribed to patients in a number of clinical settings. The present study focused on patients discharged from the hospital for a heart failure exac- as no surprise that compliance with WCD is key to its ability to prevent sudden cardiac death (Olgin et al, 2018;Reek et al, 2017) and limits the potential benefit for some patients.…”

Section: Discussionmentioning

confidence: 99%

Characterization of cardiac acoustic biomarkers in patients with heart failure

Burkhoff

Bailey

Gimbel³

2019

Noninvasive Electrocardiol

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Background The wearable cardioverter defibrillator (WCD) records electrocardiograms and cardiohemic vibrations that can be algorithmically combined to provide cardiac acoustic biomarkers (CABs). We characterized CAB variability, diurnal variations, and changes over time among heart failure patients. Methods Wearable cardioverter defibrillator heart failure patients who had CAB recordings from March 2015 to July 2017 were included. CAB parameters included: electromechanical activation time (EMAT), EMATc (EMAT/RR interval), left ventricular systolic time (LVST), LVSTc (LVST/RR interval), S3 and S4 strengths, and systolic dysfunction index (SDI). Descriptive statistics, correlation analysis, and analysis of variance were used to report temporal and clinical associations. Results One thousand and sixty‐six WCD patients met the study criteria. Diastolic CAB parameters showed significantly greater intra‐subject variability than systolic CAB parameters (>29% vs. <15%, p < .01). CAB parameters varied very little with age, gender, and ejection fraction (R2 = 0.004 to 0.06) in this heart failure population. Similarly, all CABs except SDI (R2 = 0.58) were independent of QRS duration, (R2 = −0.01 to 0.58). Heart rate had a more of significant influence on the systolic CABs than the diastolic CABs (p < .05). CABs were significantly different when measured at daytime versus nighttime (p < .01) and were significantly lower at the end of WCD wear compared with the beginning of wear (p < .05). Conclusions Noninvasive CABs offer the possibility to assess parameters associated with LV function, clinical status, and other aspects of cardiovascular physiology that differ between normal and heart failure states. The present study provides critical information about typical values in heart failure patients, intra‐subject variability, circadian rhythms, and changes over time of these parameters.

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“…As the name suggests, this defibrillator is entirely external; defibrillator, leads and electrode pads are attached to a wearable vest. It may be considered for adult patients with reduced LVEF who are waiting for a more permanent solution (cardiac DOI: http://dx.doi.org /10.5772/intechopen.82463 transplantation, transvenous implant) or those who are at a temporary risk of SCD, as in peripartum cardiomyopathy or active myocarditis [25,41].…”

Section: The Wearable Cardioverter Defibrillatormentioning

confidence: 99%

Clinical Indications for Therapeutic Cardiac Devices

Åberg¹,

Mattsson²,

Magnusson³

2019

Cardiac Pacing and Monitoring - New Methods, Modern Devices

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Both technology and clinical indications have changed since the first cardiac devices. Choosing the right therapy, or abstaining from it, is the key to good clinical management. Pacemakers effectively reduce symptoms of bradycardia, prevent syncope in patients with sick sinus syndrome, and reduce mortality in high-degree atrioventricular block. Cardiac resynchronization therapy improves symptoms and survival in heart failure patients with reduced ejection fraction and ventricular dyssynchrony. Implantable cardioverter defibrillators terminate life-threatening ventricular arrhythmias and are indicated for the prevention of sudden cardiac death, either as secondary prevention in survivors of ventricular fibrillation or ventricular tachycardia with hemodynamic compromise or as primary prevention due to heart failure with reduced ejection fraction or other miscellaneous diseases. More recently, leadless pacemakers and subcutaneous implantable cardioverter defibrillators have been developed as alternatives in specific conditions. 2 Pacemaker therapyThe medical properties of electricity have been known for some time. The physicians of ancient Rome treated acute gout with electric sea creatures. Alexander von Humboldt tested the theory of electrical conduction in biological tissue on himself. The first artificial pacemaker, powered by a hand-cranked motor, was invented by Albert Hyman in 1932. The first patient to receive an implantable pacemaker, Arne Larsson, had to wait until 1958, when he underwent the procedure at the Karolinska Clinical Indications for Therapeutic Cardiac Devices DOI: http://dx.doi.org/10.5772/intechopen.82463 University Hospital in Stockholm. He outlived both the surgeon Åke Senning and the engineer Rune Elmqvist who developed the system [1]. EtiologyThe most common etiology of bradycardia leading to pacemaker implantation is conduction tissue fibrosis, but there are several others etiologies responsible for slow heart rates according to data from registers, for example the Swedish pacemaker registry [4]. Some of these are reversible, such as infection/inflammation, metabolic conditions, and medications while others are congenital such as third-degree atrioventricular (AV) block associated with maternal systemic lupus erythematosus [5]. Pacing modeA code of four to five letters is used to describe the pacing mode. The first letter indicates where pacing occurs (where A stands for atrium, V for ventricle, and D for dual); the second describes which chamber is sensed. In the third position, the letters I (inhibit), T (trigger), or D (dual) are used to describe in which way the device responds to sensed events. An R in the fourth position means that rate response (increased pacing rate during physical exertion) is active. Finally, a fifth letter is occasionally used to describe where multicenter pacing is employed (A, V, or D) [6]. Rate responseThe purpose of rate response is to increase the heart rate in response to altered demand, and there are different solutions available to achieve this. Act...

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The wearable cardioverter-defibrillator: current technology and evolving indications

Cited by 67 publications

References 55 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

Characterization of cardiac acoustic biomarkers in patients with heart failure

Clinical Indications for Therapeutic Cardiac Devices

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