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Use of the wearable cardioverter-defibrillator (WCD) and WCD-based remote rhythm monitoring in a real-life patient cohort

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Abstract

The wearable cardioverter-defibrillator (WCD) was introduced to provide protection from sudden cardiac death (SCD) in patients with transiently elevated risk or during ongoing risk stratification. Benefits and clinical characteristics of routine WCD use remain to be assessed in larger patient populations. This study aims to identify determinants of WCD compliance, therapies, and inappropriate alarms in a real-life cohort. A total of 106 cases (68.9% male) were included between 11/2010 and 04/2016. WCD therapies, automatically recorded arrhythmia episodes, inappropriate WCD alarms, patient compliance, and outcome after WCD prescription were analyzed. Median duration of WCD use was 58.5 days. Average daily wearing time was 22.7 h. Compliance was reduced in patients ≤ 50 years. Three patients received WCD therapies (2.8%). In one case ventricular fibrillation (VF) was appropriately terminated with the first shock. Two patients received inappropriate WCD therapies due to WCD algorithm activation during ventricular pacemaker stimulation. One patient died of asystole while carrying a WCD (0.9%). Additional arrhythmias detected comprised self-terminating sustained ventricular tachycardia (VT; 2.8%), non-sustained VT (2.8%), and supraventricular arrhythmias (5.7%). Inappropriate WCD alarms due to over-/undersensing occurred in 77/106 patients (72.6%), of which 41 (38.7%) experienced ≥ 10 inappropriate WCD alarms during the prescription period. Thirteen patients (12.3%) displayed a mean of > 1 inappropriate alarms/day. WCD use was associated with high compliance and provided protection from VT/VF-related SCD. The majority of patients experienced inappropriate WCD alarms. Alterations in QRS morphology during pacemaker stimulation require consideration in WCD programming to prevent inappropriate alarms.

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Acknowledgements

This work was supported in part by research grants from the German Center for Cardiovascular Research, DZHK (Rotation Grant to MMZ), from the Cardiology Career Program by the Department of Cardiology, University Hospital Heidelberg, to H.H., from the German Cardiac Society and the Hengstberger Foundation (Klaus-Georg and Sigrid Hengstberger Scholarship to DT), from the German Heart Foundation/German Foundation of Heart Research (project F/08/14 to DT), from the Else Kröner-Fresenius-Stiftung (2014_A242 to DT), from the Joachim Siebeneicher Foundation (to DT), and from the Ministry of Science, Research and the Arts Baden-Wuerttemberg (Sonderlinie Medizin to DT).

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Authors and Affiliations

  1. Department of Cardiology, Medical University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Maura M. Zylla, Henrike A. K. Hillmann, Eberhard Scholz, Edgar Zitron, Hugo A. Katus & Dierk Thomas

  2. HCR (Heidelberg Center for Heart Rhythm Disorders), Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Maura M. Zylla, Henrike A. K. Hillmann, Eberhard Scholz, Edgar Zitron, Hugo A. Katus & Dierk Thomas

  3. DZHK (German Center for Cardiovascular Research) Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Maura M. Zylla, Hugo A. Katus & Dierk Thomas

  4. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany

    Tanja Proctor & Meinhard Kieser

Authors
  1. Maura M. Zylla
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  2. Henrike A. K. Hillmann
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  3. Tanja Proctor
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  4. Meinhard Kieser
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  5. Eberhard Scholz
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  6. Edgar Zitron
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  7. Hugo A. Katus
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  8. Dierk Thomas
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Correspondence to Dierk Thomas.

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Conflicts of interest

MMZ reports receiving travel support from Medtronic and ZOLL CMS. EZ reports receiving lecture fees/honoraria from Bayer Vital, Medtronic and St. Jude Medical. DT reports receiving lecture fees/honoraria from Bayer Vital, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer Pharma, Sanofi-Aventis, St. Jude Medical and ZOLL CMS, and research grant support from Daiichi Sankyo. The remaining authors declare that they have no conflict of interest.

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Zylla, M.M., Hillmann, H.A.K., Proctor, T. et al. Use of the wearable cardioverter-defibrillator (WCD) and WCD-based remote rhythm monitoring in a real-life patient cohort. Heart Vessels 33, 1390–1402 (2018). https://doi.org/10.1007/s00380-018-1181-x

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  • DOI: https://doi.org/10.1007/s00380-018-1181-x

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