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Background: Sudden cardiac death (SCD) accounts for 300 000 to 400 000 deaths annually in the United States. Increased implantable cardioverter-defibrillators (ICDs) implantation in older patients with more comorbid conditions have resulted in higher rates of cardiac device infections (CDI). This study was undertaken to evaluate the effectiveness of wearable cardioverter defibrillator (WCD) and to determine whether the WCD could be successfully utilized long term (≥1 year) after ICD extraction in patients at continued risk of SCD in which ICD re-implantation was not practical.
Methods: The current study is a retrospective analysis based on consecutive patients who underwent ICD explant due to device-related infections or mechanical reason between April 2007 and July, 2014. Briefly, all patients were older than 18 years of age were retrospectively identified from the national database maintained by ZOLL (Pittsburgh, PA, USA). It contains information from medical orders, including the reason for WCD use, demographic information, device data, compliance and duration of WCD use, detected arrhythmias and therapies.
Results: A total of 102 patients were identified for the study. ICD-related infections accounted for the majority of removals (95.1%) with mechanical reasons comprising the rest (4.9%). Average length of WCD use from first day of use to last recorded day of use was 638.10 days. 9 patients (8.8%) had a sustained VT/VF event that was successfully resuscitated by the WCD. 6 patients (5.8%) experienced inappropriate shocks (3 Supraventricular tachycardias and 3 inappropriate sensing). Two patients (1.9%) died of asystole while wearing the WCD, and an additional 10 patients died while not being monitored by the WCD (the majority during instructed removal of WCD in hospital/hospice). 39 patients (38.2%) ended WCD use when a new ICD was implanted, and 15 patients (14.7%) were still wearing the WCD at the time of analysis.
Conclusions: Retrospective analysis from this database indicate that in patients with a history of primary and secondary prevention ICDs explanted for infection or mechanical complication, the WCD is effective in terminating life threatening arrhythmias.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 4
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1278-078
- 2017 American College of Cardiology Foundation