Abstract 2845: Sudden Cardiac Arrest in End-Stage Renal Disease: Successful Resuscitation With Wearable Cardiac Defibrillator
Introduction: Patients with end stage renal disease (ESRD) on dialysis experience high rates of sudden cardiac arrest (SCA). ICDs are underutilized in ESRD patients due to concerns of implantation complication or low life expectancy.
Objective: We hypothesized that the majority of SCA events in ESRD patients would be due to VT/VF and that a wearable cardiac defibrillator [WCD] (LifeVest, ZOLL Lifecor Corporation) would successfully save these patients.
Methods: ECG recordings of WCD treatments and asystole events were reviewed for death in ESRD patients wearing the WCD. SCA events were defined as all potentially life-threatening arrhythmias (tachyarrhythmias and bradyarrhythmias). Data on inappropriate shocks were also collected.
Results: There were 33 ESRD dialysis patients with documented WCD shocks (mean age 60±13 years; 21 males) who were wearing WCD due to ICD explantation in 15 (35%) patients, due to documented VT/VF in 8 (24%) of patients, and due to primary prevention indications in 10 (31%) of patients. During a mean WCD usage of 2–256 (median=48) days, 26 patients developed SCA events including: 16 (62%) patients who experienced 28 VT/VF episodes; 8 (31%) had asystole, and in 2 (7%) electromechanical dissociation was identified. VT/VF arrests were successfully treated with WCD shock (28/28 shocks successfully converted). Among 16 patients receiving successful WCD shocks, 11 survived whereas 5 died within days of SCA event. Survival rate was 69% (11/16 patients). Among 10 patients with asystole or electromechanical dissociation, 9 died. In 9 (27%) patients, 15 inappropriate shocks were observed (2 patients had both appropriate and inappropriate shocks) due to noise in (7 shocks), SVT (3 shocks), NSVT/PVCs (2 shocks), and T wave oversensing (3 shocks). There was no death associated with inappropriate shocks, although 2 of 9 patients died later on for unrelated reasons.
Conclusions: VT/VF appears to be responsible for the majority of SCA in dialysis patients and these events can be successfully resuscitated with the WCD. Survival rate of 69% is far higher than a reported 5–10% survival rate of SCA victims unprotected with WCD or ICD. WCD may represent useful alternative therapy for patients unwilling or unable to receive an ICD or requiring ICD removal.