title: Utility of the Wearable Cardioverter-Defibrillator in Patients With Newly Diagnosed Cardiomyopathy: A Decade-Long Single-Center Experience.
abstract: BACKGROUND
  The wearable cardioverter-defibrillator (WCD) has emerged as a means of protecting patients with newly diagnosed nonischemic cardiomyopathy (NICM) or ischemic cardiomyopathy (ICM) against sudden cardiac death while awaiting re-evaluation of cardiac function.
  
  
  OBJECTIVE
  This study sought to characterize the risk of appropriate WCD therapy in newly diagnosed NICM and ICM patients according to cardiomyopathy etiology in an independent study.
  
  
  METHODS
  Medical records of all patients prescribed a WCD between June 2004 and May 2015 at our institution (n = 639) were analyzed, focusing on 254 patients with newly diagnosed NICM and 271 patients with newly diagnosed ICM. Patients with a prior implantable cardioverter-defibrillator or sustained ventricular arrhythmias were excluded (n = 114). The primary endpoint was appropriate WCD therapy.
  
  
  RESULTS
  Median WCD wear time was 61 days (interquartile range [IQR]: 25 to 102 days) per patient and 22 h/day (IQR: 17 to 23 h/day). During 56.7 patient-years, 0 NICM patients received an appropriate WCD shock, whereas 3 (1.2%) received an inappropriate shock. During 46.7 patient-years, 6 (2.2%) ICM patients received an appropriate shock; 5 survived the episode, and 4 survived to hospital discharge. All 6 patients with an appropriate shock were male with QRS duration >120 ms. Two (0.7%) ICM patients received an inappropriate shock.
  
  
  CONCLUSIONS
  In this independent, retrospective study, the risk of appropriate WCD therapies in patients with newly diagnosed NICM was minimal. Routine use of the WCD in this population should be prospectively evaluated. The risk of appropriate therapies in newly diagnosed ICM was comparable to that observed in prior observational studies.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Madhurmeet
authors.initials: M
authors.lastname: Singh
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Norman C
authors.initials: NC
authors.lastname: Wang
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Voigt
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: adelsteinec@upmc.edu.
authors.forename: Evan C
authors.initials: EC
authors.lastname: Adelstein
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy
keywords: sudden cardiac death; ventricular tachycardia; ventricular fibrillation