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Wearable cardioverter-defibrillator use in patients perceived to be at high risk early post-myocardial infarction.

Abstract：

OBJECTIVES:The aim of this study was to describe usage of the wearable cardioverter-defibrillator (WCD) during mandated waiting periods following myocardial infarction (MI) for patients perceived to be at high risk for sudden cardiac arrest (SCA). BACKGROUND:Current device guidelines and insurance coverage require waiting periods of either 40 days or 3 months before implanting a cardioverter-defibrillator post-myocardial infarction (MI), depending on whether or not acute revascularization was undertaken. METHODS:We assessed characteristics of and outcomes for patients who had a WCD prescribed in the first 3 months post-MI. The WCD medical order registry was searched for patients who were coded as having had a "recent MI with ejection fraction ≤35%" or given an International Classification of Diseases, Ninth Revision 410.xx diagnostic code (acute MI), and then matched to device-recorded data. RESULTS:Between September 2005 and July 2011, 8,453 unique patients (age 62.7 ± 12.7 years, 73% male) matched study criteria. A total of 133 patients (1.6%) received 309 appropriate shocks. Of these patients, 91% were resuscitated from a ventricular arrhythmia. For shocked patients, the left ventricular ejection fraction (LVEF) was ≤30% in 106, 30% to 35% in 17, >36% in 8, and not reported in 2 patients. Of the 38% of patients not revascularized, 84% had a LVEF ≤30%; of the 62% of patients revascularized, 77% had a LVEF ≤30%. The median time from the index MI to WCD therapy was 16 days. Of the treated patients, 75% received treatment in the first month, and 96% within the first 3 months of use. Shock success resulting in survival was 84% in nonrevascularized and 95% in revascularized patients. CONCLUSIONS:During the 40-day and 3-month waiting periods in patients post-MI, the WCD successfully treated SCA in 1.4%, and the risk was highest in the first month of WCD use. The WCD may benefit individual patients selected for high risk of SCA early post-MI.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Epstein AE,Abraham WT,Bianco NR,Kern KB,Mirro M,Rao SV,Rhee EK,Solomon SD,Szymkiewicz SJ

doi

10.1016/j.jacc.2013.05.086

subject

Has Abstract

pub_date

2013-11-19 00:00:00

pages

2000-2007

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(13)02834-9

journal_volume

pub_type

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Wearable cardioverter-defibrillator use in patients perceived to be at high risk early post-myocardial infarction.