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Impact of the Fibrosis-4 Index on Risk Stratification of Cardiovascular Events and Mortality in Patients with Atrial Fibrillation: Findings from a Japanese Multicenter Registry
Open AccessArticle

The Wearable Cardioverter-Defibrillator: Experience in 153 Patients and a Long-Term Follow-Up

1
First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, 68167 Mannheim, Germany
2
DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 893; https://doi.org/10.3390/jcm9030893 (registering DOI)
Received: 13 February 2020 / Revised: 9 March 2020 / Accepted: 19 March 2020 / Published: 24 March 2020
(This article belongs to the Special Issue New Approaches to the Atrial Fibrillation Management)
Background: The wearable cardioverter-defibrillator (WCD) is available for patients at high risk for sudden cardiac death (SCD) when immediate implantable cardioverter-defibrillator (ICD) implantation is not possible or indicated. Patient selection remains challenging especially in primary prevention. Long-term data on these patients is still lacking. Methods: 153 patients were included in this study. They were prescribed the WCD between April 2012 and March 2019 at the University Medical Center, Mannheim, Germany. The mean follow-up period was 36.2 ± 15.6 months. Outcome data, including all-cause mortality, were analyzed by disease etiology and ICD implantation following WCD use. Results: We analyzed 56 patients with ischemic cardiomyopathy, 70 patients with non-ischemic cardiomyopathy, 16 patients with prior need for ICD/CRT-D (device for cardiac resynchronization therapy with defibrillator) explanation, 8 patients with acute myocarditis and 3 patients with congenital diseases. 58% of the patients did not need ICD/CRT-D implantation after WCD use. 4% of all patients suffered from appropriate WCD shocks. 2 of these patients (33%) experienced appropriate ICD shocks after implantation due to ventricular tachyarrhythmias. Long-term follow-up shows a good overall survival. All-cause mortality was 10%. There was no significant difference between patients with or without subsequent ICD implantation (p = 0.48). Patients with ischemic cardiomyopathy numerically showed a higher long-term mortality than patients with non-ischemic cardiomyopathy (14% vs. 6%, p = 0.13) and received significantly more ICD shocks after implantation (10% of ischemic cardiomyopathy (ICM) patients versus 3% of non-ischemic cardiomyopathy (NICM) patients, p = 0.04). All patients with ventricular tachyarrhythmias during WCD use or after ICD implantation survived the follow-up period. Conclusion: Following WCD use, ICD implantation could be avoided in 58% of patients. Long-term follow-up shows good overall survival. The majority of all patients did not suffer from WCD shocks nor did receive ICD shocks after subsequent implantation. Patient selection regarding predictive conditions on long-term risk of ventricular tachyarrhythmias needs further risk stratification. View Full-Text
Keywords: WCD; life-vest; sudden cardiac death WCD; life-vest; sudden cardiac death
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Rosenkaimer, S.L.; El-Battrawy, I.; Dreher, T.C.; Gerhards, S.; Röger, S.; Kuschyk, J.; Borggrefe, M.; Akin, I. The Wearable Cardioverter-Defibrillator: Experience in 153 Patients and a Long-Term Follow-Up. J. Clin. Med. 2020, 9, 893.

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