Potential roles of the wearable cardioverter-defibrillator in acute phase care of patients at high risk of sudden cardiac death: A single-center Japanese experience

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• 作者：Shingo Sasaki ; MD ; PhD ; FJCC^a ; Yoshihiro Shoji ; MD^b ; Yuji Ishida ; MD ; PhD^b ; Takahiko Kinjo ; MD ; PhD^b ; Yuichi Tsushima ; MD^b ; Maiko Seno ; MD^b ; Fumie Nishizaki ; MD ; PhD^b ; Taihei Itoh ; MD ; PhD^b ; Kei Izumiyama ; MD ; PhD^b ; Takashi Yokota ; MD ; PhD^b ; Hiroaki Yokoyama ; MD ; PhD^b ; Masahiro Yamada ; MD ; PhD^b ; Daisuke Horiuchi ; MD ; PhD^a ; Masaomi Kimura ; MD ; PhD^b ; Takumi Higuma ; MD ; PhD ; FJCC^b ; Hirofumi Tomita ; MD ; PhD^b ; Ken Okumura ; MD ; PhD ; FJCC^c ; ^{okumura@hirosaki-u.ac.jp}
• 关键词：Wearable cardioverter-defibrillator ; Sudden cardiac death ; Ventricular tachyarrhythmias
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：359-363
• 全文大小：558 K
• 卷排序：69

文摘

The wearable cardioverter-defibrillator (WCD) has been expected to play a role as an effective bridge therapy to implantable cardioverter-defibrillator (ICD) implantation in patients at high risk of ventricular tachyarrhythmias (VA). Although WCD has been available since April 2014 in Japan, its usefulness remains unclear.Methods and resultsDuring the early period after hospitalization, patients at high risk of VA after excluding some elderly patients were prescribed WCD. The consecutive 50 patients with WCD use (median age 56 years, 38 for secondary prevention) were studied. We analyzed clinical efficacy and safety of WCD, and examined its potential roles. Of the 50 patients, 38 used WCD only during hospitalization. During WCD use [median 16 (IQR 8–33) days], all patients wore WCD for 98% of a day regardless of in or out-of-hospital use. Sustained VA was detected in 4 patients (8%; for primary prevention in 1) with 7 episodes, and 6 of 7 episodes required shock therapy. Of the 6 shock therapies, 4 were for sustained ventricular tachycardia with the median rate of 236 beats/min (IQR 203–250), and the other 2 for ventricular fibrillation. Subsequently, only 27 patients (54%) of all underwent ICD implantation following the WCD use, because of reduced risk of VA after optimal pharmacological therapy or improvement in the left ventricular function.ConclusionsThe WCD use for the acute phase care of patients at high risk of VA can be safe and effective, and may be useful for evaluating indication of ICD implantation.