Author + information
- Received June 13, 2016
- Revision received August 23, 2016
- Accepted September 1, 2016
- Published online March 20, 2017.
- Kenneth A. Ellenbogen, MDa,∗ (, )
- Jayanthi N. Koneru, MDa,
- Parikshit S. Sharma, MD, MPHa,
- Sanjay Deshpande, MDb,
- Chingping Wan, MD, MSHCPMc and
- Steven J. Szymkiewicz, MDc
- aDivision of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- bDepartment of Cardiac Electrophysiology, Columbia St. Mary’s Hospital, Milwaukee, Wisconsin
- cZoll Medical Corporation, Zoll, Pittsburgh, Pennsylvania
- ↵∗Address for correspondence:
Dr. Kenneth A. Ellenbogen, Division of Cardiology, Virginia Commonwealth University, P.O. Box 980053, 1200 East Marshall Street, Gateway Building, 3rd Floor, Richmond, Virginia 23298.
Objectives This study reports on the time course of reimplantation and benefits of the wearable cardioverter-defibrillator (WCD) in patients post implantable cardioverter-defibrillator (ICD) explantation.
Background The WCD is used to treat patients at high risk for ventricular tachycardia (VT) and ventricular fibrillation (VF), including patients with ICD–related infections who undergo device removal and cannot be immediately reimplanted.
Methods This retrospective study included consecutive patients from 2002 to 2014 who underwent ICD removal because of device-related infection and were prescribed a WCD. WCD-stored electrocardiograms were reviewed. Event outcome was assessed through either the manufacturer WCD registry or the Social Security death index search.
Results A total of 8,058 patients (mean age 62 ± 14 years, 75% male) were included in the analysis. Median time to reimplantation of an ICD was 50 days (interquartile range: 24 to 83 days). While wearing the WCD, 334 patients (4%) experienced 406 VT/VF events, of which 348 events were treated. Shocks were averted in 54 events by conscious patients. The overall 24-h survival, both treated and nontreated, was 93% (312 of 334). VT/VF occurrence was the highest in the initial weeks after ICD removal (0.9%, 0.7%, and 0.7% per week for weeks 1, 2, and 3, respectively). The 12-month cumulative event rate was 10%. For all patients, the 30-day post-event survival was 81%. An ICD was reimplanted in 80% of patients.
Conclusions The risk of VT/VF reaches 4% during the first 2 months and 10% at 1 year after ICD removal. WCD demonstrated a high efficacy for protecting patients from VT/VF. Clinicians may use the WCD as an ICD alternative when reimplantation is medically delayed.
- cardiac device infection
- implantable cardioverter-defibrillator
- sudden cardiac arrest
- ventricular arrhythmia
- wearable cardioverter-defibrillator
Drs. Wan and Szymkiewicz are Zoll employees. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 13, 2016.
- Revision received August 23, 2016.
- Accepted September 1, 2016.
- 2017 American College of Cardiology Foundation