Abstract 17589: Use of a Wearable Cardioverter Defibrillator (WCD) to Protect Patients After ICD Explantation: Results From the National Registry
Introduction: The WCD is used to treat patients (pts) at high risk of VT/VF until ICD therapy can be implemented as well as for pts with ICDs who undergo device removal and treatment of an underlying infectious process. In non-pacemaker dependent pts for whom an ICD must be removed due to infection, the WCD is now routine therapy, allowing the pt to be managed as an outpatient until the infection is resolved. Re-implantation may be postponed for weeks to months depending upon the nature of the infection being treated. The current study sought to report the outcome of using a WCD in pts who underwent ICD explantation. We report on the time course of re-implantation and the use of the WCD in patients after ICD explantation.
Methods: Medical orders from 1/2008 through 12/2013 were reviewed for pts prescribed a WCD after ICD explantation. Demographics and WCD-stored electrocardiogram were assessed. A shockable arrhythmia event was defined as all sustained VT or VF occurring within a single 24-hour period. Duration of WCD use and reason for ending use were also evaluated.
Results: A total of 8,058 pts were identified. Mean age was 62 ± 14 years; male pts consisted of 75% of the study population. While wearing the WCD, 280 (3%) pts experienced 334 VT or VF events, of which 328 were successfully treated by the WCD. The 24-hour survival was 93% (310/334). VT or VF occurrence was highest in the initial weeks following ICD removal (0.7, 0.6 and 0.7 per pt-week for weeks 1, 2 and 3 respectively). Two-month cumulative event rate was 4%. Median time to re-implantation was 48 (IQR, 24-82) days. Thirty-nine percent of the pts wore the WCD for more than 2 months (Figure).
Conclusion: After ICD explantation, pts were at highest risk of VT or VF during the initial 3 weeks. The WCD demonstrated a high efficacy for resuscitating pts from VT/VF events, with 30-day survival rate being 79% and 90-day being 71%.
Author Disclosures: C. Wan: Employment; Significant; ZOLL. K.A. Ellenbogen: None. C.J. Love: None. S. Deshpande: None. S.J. Szymkiewicz: Employment; Significant; ZOLL.
- © 2015 by American Heart Association, Inc.