Sink or Swim
In the current issue of Circulation: Arrhythmia and Electrophysiology, Zishiri et al1 evaluate the risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction. Patients with revascularization, including 2198 surgical and 1951 percutaneous intervention patients with left ventricular ejection fraction (LVEF) ≤35% from the Cleveland Clinic were compared with 809 patients in the wearable cardioverter defibrillator (WCD) postmarket US database. Early 90-day mortality was higher among the patients who did not receive a WCD at discharge, including coronary artery bypass graft and percutaneous transluminal coronary angioplasty (PCI) patients, compared with the WCD registry patients. Patients with WCD also had a lower risk of long-term mortality. However, as only 1.3% of the WCD patients received an appropriate therapy, the mortality differences between the 2 groups cannot be explained entirely by prevention of sudden arrhythmic death.
Article see p 117
Approved by the US Food and Drug Administration in 2001, the WCD (ZOLL Lifecore Corp, Pittsburgh, PA) is a novel device that offers potentially life-saving therapy to a specific patient niche—patients who are at risk for sudden death from ventricular arrhythmias, who cannot or should not receive an implantable cardioverter defibrillator (ICD) for what is generally a brief period of time. Data from 3569 patients in the nationwide registry showed that the WCD is effective at treating ventricular tachycardia (VT) and ventricular fibrillation (VF), with 100% (76 of 76) first shock success for unconscious VT/VF and 99% (79 of 80) for all VT/VF.2 Importantly, patient compliance was high, with >50% of patients wearing the WCD 90% of the time. More than a decade has passed since initial approval, but the indications remain unclear.
One of the primary aims of this study was to determine whether survival was influenced by hospital discharge with a WCD in patients …