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Wearable cardioverter-defibrillator as a bridge to cardiac transplantation: A national database analysis.

AbstractBACKGROUND:
Life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD) are common in patients awaiting heart transplantation (HT), and the implantable cardioverter-defibrillator (ICD) is often used for primary prevention in this setting. Use of ICDs in these patients is not without risks and is sometimes contraindicated. The wearable cardioverter-defibrillator (WCD) may be a reasonable alternative to bridge the period of risk leading up to HT.
METHODS:
We obtained a convenience sample of patients prescribed an WCD as a bridge therapy to HT. The available data consisted of demographics, cardiac transplantation status, associated comorbidities, device use, device-stored electrocardiogram (ECG) and reason for discontinuing the WCD. Statistical analyses were performed using SPSS version 17 and GraphPad PRISM 5.
RESULTS:
The registry included 121 patients consisting of 83 (69%) men and 38 (31%) women. The mean age was 44 ± 18 years. Mean ejection fraction was 25 ± 15%. Non-ischemic cardiomyopathy (CMP) was the underlying diagnosis in 67 (55%) patients, whereas 21 (17%) patients had ischemic CMP and 33 (27%) had a mixed or uncharacterized CMP. New York Heart Association Class III heart failure was present in 32% and 34% were in Class IV. Eighty-eight patients (73%) were being evaluated for HT or were on an HT waiting list, and 33 patients (27%) had had a prior HT, experienced rejection, and were awaiting re-transplantation. The patients wore the WCD for an average of 127 ± 392 days (median 39 days) with average daily use of 17 ± 7 hours (median 20 hours). Seven patients (6%) received appropriate WCD shocks. Fifty-one patients (42%) ended use after ICD implantation and 13 patients (11%) after HT. There were 11 deaths (9%).
CONCLUSIONS:
A significant proportion of patients on the HT waiting list will have VA. WCD use in our study showed high compliance and efficacy and a low complication rate, suggesting that the WCD is a reasonable bridge therapy for preventing SCD in patients awaiting HT.
AuthorsMadalina Opreanu, Chingping Wan, Vini Singh, Negar Salehi, Jaffri Ahmad, Steven J Szymkiewicz, Ranjan K Thakur
JournalThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 34 Issue 10 Pg. 1305-9 (Oct 2015) ISSN: 1557-3117 [Electronic] United States
PMID26094085 (Publication Type: Journal Article)
CopyrightCopyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
Topics
  • Adult
  • Cardiomyopathies (complications, therapy)
  • Databases, Factual
  • Death, Sudden, Cardiac (prevention & control)
  • Defibrillators, Implantable
  • Electrocardiography
  • Female
  • Heart Failure (complications, therapy)
  • Heart Transplantation
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tachycardia, Ventricular (prevention & control)
  • United States

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