Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Odeneg, T.
Indications for and outcome in patients with the wearable cardioverter defibrillator (WCD) in Austria. Results of the Austrian Lifevest Registry
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2018. pp. 103
[OPEN ACCESS]
FullText
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Manninger-Wünscher Martin
- Scherr Daniel
- Altmetrics:
- Abstract:
- Background: The wearable cardioverter defibrillator (WCD) is a safe and effective bridging option for patients with temporary elevated risk of sudden cardiac death (SCD) or temporary contraindication for implantable cardiac defibrillator (ICD) implantation. However patient compliance plays the key role. Objectives: The aim of this study was to provide nationwide real-world data of patients receiving this WCD in Austria. Methods: Observational study including 448 patients in 48 centres with prescribed WCD in Austria between 2010 and 2016. Results: Main WCD indications were: severe non-ischemic cardiomyopathy (21%), recent myocardial infarction and percutaneous coronary intervention (PCI) (20%) and stable coronary artery disease with PCI/ coronary artery bypass grafting (14%). Eleven patients (2.5%) received 22 appropriate WCD shocks, and a total of 165 events of malignant ventricular arrhythmias occurred in our patient cohort. However, SCD risk varied between different aetiologies. Eight out of eleven (73%) patients received their first WCD shock within 30 days; Furthermore sustained hemodynamically tolerated VTs were detected in 15 patients and atrial fibrillation was newly detected in 3 patients. Two patients (0.4%) received three inappropriate shocks. Wearing compliance was 23.5 h/d in a wearing period of 54 [1-436] days. The vast majority of automatic alarms occurred due to artefacts (97%). Higher body mass index was associated with higher incidence of artefacts and failed alarms. Main reasons for termination of the WCD therapy were ICD implantation (55.5%) and improvement of LVEF to >35% (33%). Conclusion: The WCD is an effective and safe treatment option in patients who are either at a temporary elevated risk of SCD or temporary contraindication of ICD implantation, with a 2.5% shock rate overall and a widely varying shock rate depending on WCD indication. WCD compliance remains high with a median wearing duration of 23.5h [1-24], which may be influenced by patient-centred nurse-based training and remote monitoring.