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Takotsubo cardiomyopathy (TCM) is a reversible diseas, often associated with stress. The prognosis is favorable with a low risk of sudden death (SCD) and the utility of a wearable cardioverter-defibrillator (WCD) in the acute phase, while the left ventricular ejection fraction (EF) is < 35%, is unknown. To understand this population, we reviewed the database of TCM patients who were prescribed a WCD.
The WCD database included all patients who wore a WCD the United States, from August 2007 through February 2012. The database contains indications, baseline demographics (age and sex), compliance, reasons for ending use, and events. TCM patients were identified by searching the database for ICD-9 code 429.83, or medical order notes. A physician determined whether WCD shocks to be appropriate. Mortality outcomes of WCD patients were determined from the Social Security Death Index (SSDI). A non-compliant patient was one who reported stopping WCD use prior to discontinuation of therapy by a physician.
One-hundred and two patients with mean age 63 ± 12 years, 11% men, had an initial EF of 27 ± 6 % at the time of WCD prescription. WCD was indicated as primary prevention in 93% of patients, while 7% had experienced a prior sustained VA event. The mean days of use was 44 ± 31 days and the average follow-up period was 440 ± 374 days with a median of 288 days. WCD compliance was assessed as % days worn and % hours/day worn: 95% of patients wore the WCD > 90% of prescribed days and 72% of patients wore the WCD > 90% of prescribed hours. Outcomes: two patients (2%) experienced appropriate shocks for VA; two patients (2%) experienced significant bradyarrhythmias needing pacing therapy; one patient received two inappropriate shocks; two patients died during the prescription period – one with asystole, and one while not wearing the WCD; five patients died after discontinuing WCD usage, two of whom had an EF ≥ 35% at the time of WCD discontinuation.
The WCD was used with a compliance of > 90%. The device detects VAs reliably with a low risk of inappropriate shocks. TCM may be associated with a significant risk of death due to tachy- or brady-arrhythmias and the risk of SCD may persist even if EF increases ≥ 35%.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Devices Ill – Use of Arrhythmia Devices in Novel Patient Populations
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1235M-31
- 2013 American College of Cardiology Foundation