Use of the wearable cardioverter defibrillator in high-risk cardiac patients: data from the Prospective Registry of Patients Using the Wearable Cardioverter Defibrillator (WEARIT-II Registry).

Abstract

BACKGROUND:

Prospective data on the safety and efficacy of the wearable cardioverter defibrillator (WCD) in a real-world setting are lacking. The Prospective Registry of Patients Using the Wearable Defibrillator (WEARIT-II) Registry was designed to provide real-world data on the WCD as a strategy during a period of risk stratification.

METHODS AND RESULTS:

The WEARIT-II Registry enrolled 2000 patients with ischemic (n=805, 40%), or nonischemic cardiomyopathy (n=927, 46%), or congenital/inherited heart disease (n=268) prescribed WCD between August 2011 and February 2014. Clinical data, arrhythmia events, implantable cardioverter defibrillator implantation, and improvement in ejection fraction were captured. The median age was 62 years; the median ejection fraction was 25%. The median WCD wear time was 90 days, with median daily use of 22.5 hours. There was a total of 120 sustained ventricular tachyarrhythmias in 41 patients, of whom 54% received appropriate WCD shock. Only 10 patients (0.5%) received inappropriate WCD therapy. The rate of sustained ventricular tachyarrhythmias by 3 months was 3% among patients with ischemic cardiomyopathy and congenital/inherited heart disease, and 1% among nonischemic patients (P=0.02). At the end of WCD use, 840 patients (42%) were implanted with an implantable cardioverter defibrillator. The most frequent reason not to implant an implantable cardioverter defibrillator following WCD use was improvement in ejection fraction.

CONCLUSIONS:

The WEARIT-II Registry demonstrates a high rate of sustained ventricular tachyarrhythmias at 3 months in at-risk patients who are not eligible for an implantable cardioverter defibrillator, and suggests that the WCD can be safely used to protect patients during this period of risk assessment.

• Authors: Valentina Kutyifa, Arthur J Moss, Helmut Klein, Yitschak Biton, Scott McNitt, Bonnie MacKecknie, Wojciech Zareba, Ilan Goldenberg
• Journal: Circulation (Circulation) Vol. 132 Issue 17 Pg. 1613-9 (Oct 27 2015) ISSN: 1524-4539 [Electronic] United States
• PMID: 26316618 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Heart Association, Inc.

Chemical References

• Cardiovascular Agents

Topics

• Aged
• Arrhythmias, Cardiac (drug therapy, etiology, prevention & control, therapy)
• Cardiomyopathies (complications)
• Cardiovascular Agents (therapeutic use)
• Combined Modality Therapy
• Death, Sudden, Cardiac (prevention & control)
• Defibrillators (adverse effects, statistics & numerical data)
• Defibrillators, Implantable (statistics & numerical data)
• Electric Countershock (instrumentation)
• Female
• Follow-Up Studies
• Heart Defects, Congenital (complications)
• Humans
• Male
• Middle Aged
• Myocardial Ischemia (complications)
• Patient Compliance
• Prescriptions (statistics & numerical data)
• Prospective Studies
• Registries
• Stroke Volume