title: National experience with long-term use of the wearable cardioverter defibrillator in patients with cardiomyopathy.
abstract: OBJECTIVE
  The wearable cardioverter defibrillator (WCD) is generally used for short periods of sudden cardiac death (SCD) risk; circumstances may occasionally result in prolonged use (over 1 year). The aim of this study was to determine the benefits and risks of prolonged use in patients with systolic heart failure (HF).
  
  
  METHODS
  ZOLL's post-market US database included adult patients (≥18 years) with ischemic and/or non-ischemic cardiomyopathy (ICM, NICM) and at least 1 year of use. Cox-regression was used to identify factors associated with survival with WCD use, and reasons for stopping use were entered as time-dependent factors.
  
  
  RESULTS
  Among 220 patients, age (mean ± SD) 55.4 ± 14.8 years, WCD use 451.4 ± 289.9 days, and 67.3 % were male and their left ventricle ejection fraction (EF) averaged 20.9 ± 7.2 %. Eighty-nine (40.5 %) were continuing WCD use at the last follow-up. Thirty-six (16.4 %) and 56 (25.5 %) patients discontinued WCD use because of EF recovery and implantable cardioverter (ICD) implantation, respectively. Nine patients (4.1 %) received appropriate shock therapy for 13 episodes of sustained ventricular tachyarrhythmia with 12 (92.3 %) successful shocks. One patient died of refractory ventricular fibrillation. One patient died from sinus bradycardia transitioning to asystole. Eight patients (3.6 %) had nine episodes of non-fatal inappropriate shocks.
  
  
  CONCLUSIONS
  Long-term use of the WCD is safe and effective. Recovery of EF was seen in significant number of patients even after 1 year of WCD use.
authors.affiliation: Cardiovascular Disease Fellowship Program, Michigan State University/Sparrow Thoracic and Cardiovascular Institute, 1200 E Michigan Ave; Suite 580, East Lansing, MI, 48912, USA.
authors.forename: Madhab
authors.initials: M
authors.lastname: Lamichhane
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gardiner
authors.affiliation: ZOLL, Pittsburgh, PA, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Bianco
authors.affiliation: ZOLL, Pittsburgh, PA, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Szymkiewicz
authors.affiliation: Cardiovascular Disease Fellowship Program, Michigan State University/Sparrow Thoracic and Cardiovascular Institute, 1200 E Michigan Ave; Suite 580, East Lansing, MI, 48912, USA. thakur@msu.edu.
authors.forename: Ranjan K
authors.initials: RK
authors.lastname: Thakur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D047548:Defibrillators / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cardiomyopathy; Heart failure; Long-term use; Wearable cardioverter defibrillator