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Kovacs B, Burri H, Reek S, Sticherling C, Linka A, Ammann P, Mueller A, Kobza R, Haegeli L, Mayer K, Eriksson U, Reichlin T, Steffel J, Saguner A, Duru F. High incidence of inappropriate alarms in patients with wearable cardioverter-defibrillators: findings from the swiss WCD registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The wearable cardioverter defibrillator (WCD) uses surface electrodes built into the vest to detect underlying arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts.
Purpose
The aim of this study was to assess the alarm burden in patients and its possible impact on clinical outcomes.
Methods
The Swiss WCD Registry is a nationwide, retrospective, observational registry. Patients were included from December 2011 until February 2018. Clinical characteristics and data from the WCDs, including alarm burden were analysed. Recordings ≥30 seconds of length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia or artefact.
Results
A total of 10'653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0±1.6 months. Among these, the episode duration was 30 seconds or more in 2996 (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate arrhythmia detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) supraventricular tachycardia). Two-hundred and seven patients (45.0%) had 3 or more alarms per month, whereas 49 patients (10.7%) had 1 or more alarms per day. Body mass index (BMI) was significantly higher in patients with 3 or more alarms per month (p=0.002, 25.6 vs. 27.3 kg/m2) High alarm burden was not associated with a lower average daily wear time (20.8 hours vs 20.7 hours, p=0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs 47.3%, p=0.156).
Conclusions
In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden did not lead to a decreased adherence, as determined by average daily wear-times. Obesity was significantly associated with a higher alarm burden.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - H Burri
- University Hospital of Geneva, Cardiology, Geneva, Switzerland
| | - S Reek
- Hirslanden Medical Center, Cardiology, Aarau, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Linka
- Cantonal Hospital Winterthur, Cardiology, Winterthur, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology, St. Gallen, Switzerland
| | - A.S Mueller
- Triemli Hospital, Cardiology, Zurich, Switzerland
| | - R Kobza
- Lucerne Cantonal Hospital, Cardiology, Lucerne, Switzerland
| | - L Haegeli
- Cantonal Hospital Aarau, Cardiology, Aarau, Switzerland
| | - K Mayer
- Cantonal Hospital Grison, Cardiology, Chur, Switzerland
| | - U Eriksson
- GZO Zurich Regional Health Center, Cardiology, Wetzikon, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - J Steffel
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Cardiology, Zurich, Switzerland
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