Author + information
- Received July 17, 2017
- Revision received September 18, 2017
- Accepted September 27, 2017
- Published online February 19, 2018.
- Jordan S. Leyton-Mange, MDa,
- William J. Hucker, MD, PhDa,
- Nino Mihatov, MDa,
- Matthew Reynolds, MD, MScb,
- Christine Albert, MD, MPHc,
- Steven A. Lubitz, MD, MPHa,d and
- David J. Milan, MDa,∗ ()
- aCardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- bDepartment of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
- cCenter for Arrhythmia Prevention, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- dProgram in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts
- ↵∗Address for correspondence:
Dr. David J. Milan, Cardiovascular Research Center, Massachusetts General Hospital, 55 Fruit Street, GRB-109, Boston, Massachusetts 021241.
Objectives This study sought to characterize the experience in a cohort of patients prescribed a wearable cardioverter-defibrillator (WCD) over a 2-year interval at 2 academic medical centers.
Background The WCD is available for patients felt to be at high risk of sudden cardiac death. However, there is a lack of randomized data to guide its use and prescribing patterns vary.
Methods We retrospectively reviewed indications and therapies of all WCD prescriptions over a 2-year period from 2 large academic medical centers. Data on compliance and treatment events of patients wearing the WCD were reviewed.
Results Among the 147 patients prescribed a WCD, 80% were male with an age of 59 ± 14 years. The WCD was prescribed for the following reasons: primary prevention in the setting of a left ventricular ejection fraction ≤35% (53%), secondary prevention when an implantable cardioverter-defibrillator was not implanted (16%), implantable cardioverter-defibrillator explantation (23%), and other high-risk scenarios for arrhythmic sudden death (9%). The median wear duration was 50 days (interquartile range [IQR]: 25 to 85 days) with a median of 21.0 h of wear per day (IQR: 15.0 to 22.8 h). High-voltage treatment was delivered in 3 separate patients, 2 of whom died. The third patient received 3 WCD shocks without restoration of a perfusing rhythm and ultimately was resuscitated by emergency responders. No patients received inappropriate therapies.
Conclusions Events requiring therapy were rare and no lives were directly saved by the WCD. Future efforts are needed to improve identification of patients most likely to benefit from a WCD.
Dr. Hucker was supported by Award Number T32HL007208 from the National Heart, Lung, and Blood Institute. Dr. Reynolds has served as a consultant for Medtronic and St. Jude Medical. Dr. Lubitz has received support from the National Institutes of Health/National Heart, Lung, and Blood Institute (grant no. K23HL114724) and the Doris Duke Charitable Foundation (Clinical Scientist Development Award no. 2014105); has served as a consultant to St. Jude Medical; and has received sponsored research support from Boerhinger Ingelheim. Dr. Milan has received support from the National Institutes of Health/National Heart, Lung, and Blood Institute (grant nos. R01 HL127692 and R01 HL132905). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Leyton-Mange and Hucker contributed equally to this work.
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 July 17, 2017.
- Revision received September 18, 2017.
- Accepted September 27, 2017.
- 2018 American College of Cardiology Foundation
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