Use of the wearable external cardiac defibrillator in children.
BACKGROUND
The wearable cardiac defibrillator (WCD) is an alternative to the implantation of cardioverter defibrillator (ICD) for patients at risk for sudden death who do not fulfill standard criteria for ICD implantation or in whom the risk:benefit ratio is equivocal. Published data pertaining to the WCD in children is sparse. We describe the utility of the WCD in children at a single tertiary care center.


METHODS
We retrospectively identified all patients aged birth to 18 years of age who were prescribed a WCD between January 1, 2007, and June 30, 2009. Patient information regarding diagnosis, clinical history, electrocardiograms, rhythm reports, and outcome at last follow-up was reviewed. Information regarding the WCD was obtained including indication for use, patient compliance, and accuracy of rhythm determination, inappropriate and appropriate shock events, and other complications.


RESULTS
Since 2007, four patients age less than or equal to 18 years have been prescribed the WCD at our institution. None of the patients had an inappropriate shock. Two patients had documented noncompliance with wear, which resulted in failure to detect and treat a life-threatening arrhythmia in one. Two patients required downsizing of the WCD during use in order to improve electrode contact and rhythm detection.


CONCLUSIONS
The WCD is an option for children of appropriate size who are at increased risk for sudden cardiac death, but in whom the risk of ICD implantation outweighs the benefit. Careful patient selection and education is important to ensure safety, as noncompliance with wear was common in this series of children.
Everitt
Melanie D
MD
Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, USA. melanie.everitt@imail.org
Saarel
Elizabeth V
EV
D000293:Adolescent; D009202:Cardiomyopathies / Q000139:chemically induced / Q000628:therapy*; D002648:Child; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D047548:Defibrillators / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D018579:Patient Selection; D012189:Retrospective Studies; D012306:Risk; D017180:Tachycardia, Ventricular / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy*