Medizinische Universität Graz - Research portal
Selected Publication:
Rohrer, U.
Multiparameter monitoring and sudden cardiac death prevention with a wearable cardioverter defibrillator from diagnosis to cardiac rehabilitation
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2023. pp. 90
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- Authors Med Uni Graz:
- Rohrer Ursula
- Advisor:
- Manninger-Wünscher Martin
- Plank Gernot
- Scherr Daniel
- Altmetrics:
- Abstract:
- Background and Aim: Patients at risk of sudden cardiac death (SCD) may not be eligible for implantation of an implantable cardioverter defibrillator either due to temporary contraindications or due to a transient SCD risk. The wearable cardioverter defibrillator (WCD) was developed to overcome these situations as a temporary treatment option. This thesis will cover two different clinical aspects: (1) SCD protection after acute myocardial infarction (AMI): The “VEST” trial failed to show a benefit on arrhythmic mortality in patients prescribed with a WCD after AMI with left ventricular ejection fraction≤35% (LVEF), having a lower-than-expected wearing compliance. The aim was to investigate outcomes in a well-compliant Austrian WCD cohort meeting all in- and none of the exclusion criteria. (2) Cardiac rehabilitation (CR) with a WCD: Patients undergoing CR with a WCD have not been studied so far. The aim was to assess feasibility and safety and describe outcomes in this cohort as CR is one of the therapeutic cornerstones in patients with an underlying disease. Material and Methods: First, 896 patients prescribed with WCD in 60 Austrian centers have been included in the Austrian WCD registry between 2010 and 2020. Within the Austrian WCD registry two sub cohorts were identified to answer the research questions: (1) All Austrian WCD patients being eligible according to the VEST trial in- and exclusion criteria formed the Austrian VEST cohort, were analysed, and compared to the original VEST cohort. (2) Last, all patients who underwent a CR with a WCD have been included and studied to answer the research question. Results: (1) 105/896 patients received a WCD after AMI with a reduced LVEF. The arrhythmic and all-cause mortality did not significantly differ between the Austrian and the original VEST cohort, despite a good wearing compliance in the Austrian cohort. (2) 55/896 patients completed a CR of 28 days. Apart from minor adjustments of the fabric garment and device settings, no severe WCD-related adverse events happened during CR stay. Only 6% of the WCD registry were referred to and underwent CR. Conclusion: (1) The WCD is a safe treatment option in a highly selected cohort of patients with LVEF ≤35% after AMI. However, despite excellent WCD wearing duration in our cohort, as opposed to the VEST study cohort, the arrhythmic mortality rate was not significantly lower as in the VEST study. (2) Completing an exercise-based CR with a WCD seems to be feasible and safe while CR is strongly underutilized in this cohort despite clearly stated guideline recommendations.