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Veltmann C, Winter S, Duncker D, Jungbauer CG, Wäßnig NK, Geller JC, Erath JW, Goeing O, Perings C, Ulbrich M, Roser M, Husser D, Gansera LS, Soezener K, Malur FM, Block M, Fetsch T, Kutyifa V, Klein HU. Protected risk stratification with the wearable cardioverter-defibrillator: results from the WEARIT-II-EUROPE registry. Clin Res Cardiol 2020; 110:102-113. [PMID: 32377784 PMCID: PMC7806570 DOI: 10.1007/s00392-020-01657-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/25/2020] [Indexed: 12/22/2022]
Abstract
Background The prospective WEARIT-II-EUROPE registry aimed to assess the value of the wearable cardioverter-defibrillator (WCD) prior to potential ICD implantation in patients with heart failure and reduced ejection fraction considered at risk of sudden arrhythmic death. Methods and results 781 patients (77% men; mean age 59.3 ± 13.4 years) with heart failure and reduced left ventricular ejection fraction (LVEF) were consecutively enrolled. All patients received a WCD. Follow-up time for all patients was 12 months. Mean baseline LVEF was 26.9%. Mean WCD wearing time was 75 ± 47.7 days, mean daily WCD use 20.3 ± 4.6 h. WCD shocks terminated 13 VT/VF events in ten patients (1.3%). Two patients died during WCD prescription of non-arrhythmic cause. Mean LVEF increased from 26.9 to 36.3% at the end of WCD prescription (p < 0.01). After WCD use, ICDs were implanted in only 289 patients (37%). Forty patients (5.1%) died during follow-up. Five patients (1.7%) died with ICDs implanted, 33 patients (7%) had no ICD (no information on ICD in two patients). The majority of patients (75%) with the follow-up of 12 months after WCD prescription died from heart failure (15 patients) and non-cardiac death (15 patients). Only three patients (7%) died suddenly. In seven patients, the cause of death remained unknown. Conclusions Mortality after WCD prescription was mainly driven by heart failure and non-cardiovascular death. In patients with HFrEF and a potential risk of sudden arrhythmic death, WCD protected observation of LVEF progression and appraisal of competing risks of potential non-arrhythmic death may enable improved selection for beneficial ICD implantation. Graphic abstract ![]()
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Affiliation(s)
- Christian Veltmann
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - David Duncker
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | | | - J Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-Von-Guericke University School of Medicine, Magdeburg, Germany
| | - Julia W Erath
- Abteilung für Klinische Elektrophysiologie, Medizinische Klinik III, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | | | | | | | - Mattias Roser
- Klinikum Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Daniela Husser
- Klinik für Kardiologie, Herzzentrum Leipzig, Leipzig, Germany
| | - Laura S Gansera
- Klinik für Kardiologie, Klinikum Augsburg, Augsburg, Germany
| | | | | | - Michael Block
- Klinik für Kardiologie, Klinikum Augustinum München, Munich, Germany
| | - Thomas Fetsch
- CRI-Clinical Research Institute München, Munich, Germany
| | - Valentina Kutyifa
- Medical Center, Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Helmut U Klein
- Medical Center, Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
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