Protection from outpatient sudden cardiac death following ICD removal using a wearable cardioverter defibrillator.
BACKGROUND
An implantable cardioverter defibrillator (ICD) is effective in preventing sudden cardiac death (SCD). Once an ICD is removed and reimplantation is not feasible, a wearable cardioverter defibrillator (WCD) may be an alternative option. We determined the effectiveness of WCD for SCD prevention in patients who were discharged after ICD removal.


METHODS
A retrospective study was conducted on all WCD (LifeVest, ZOLL, Pittsburgh, PA, USA) patients who underwent ICD removal due to cardiac device infections (CDIs) at two referral centers between January 1, 2005 and December 31, 2009. Clinical characteristics, device information, and WCD data were analyzed. Sudden cardiac arrest was defined as all sustained ventricular tachycardia (VT) and ventricular fibrillation occurring within a single 24-hour period.


RESULTS
Ninety-seven patients (mean age 62.8 ± 13.3, male 80.4%) were included in the study. The median duration of antibiotic use was 14.7 days (interquartile range [IQR] 10-30). The median daily WCD use was 20 hours/day and the median length of use was 21 days (IQR 5-47). A total of three patients were shocked by WCD. Two patients had four episodes of sustained VT, successfully terminated by the WCD. A third patient experienced two inappropriate treatments due to oversensitivity of the signal artifact. Three patients experienced sudden death outside the hospital while not wearing the device. Five patients died while hospitalized.


CONCLUSIONS
WCD can prevent SCD, until ICD reimplantation is feasible in patients who underwent device removals for CDI. However, patient compliance is essential for the effective use of this device.
Division of Cardiovascular Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Tanyanan
T
Tanawuttiwat
Juan D
JD
Garisto
Arturo
A
Salow
Joann M
JM
Glad
Steve
S
Szymkiewicz
Heath E
HE
Saltzman
Steven P
SP
Kutalek
Roger G
RG
Carrillo
D000553:Ambulatory Care / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D047548:Defibrillators / Q000145:classification / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D020878:Device Removal / Q000401:mortality; D004554:Electric Countershock / Q000295:instrumentation* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000401:mortality*; D010045:Outpatients / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
ICD removal; sudden cardiac death; wearable cardioverter defibrillator