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Observational Study
. 2014 May;19(3):247-57.
doi: 10.1111/anec.12119. Epub 2013 Nov 20.

Sudden cardiac arrest in hemodialysis patients with wearable cardioverter defibrillator

Chingping Wan  1 , Charles A Herzog, Wojciech Zareba, Steven J Szymkiewicz
Affiliations
Observational Study

Sudden cardiac arrest in hemodialysis patients with wearable cardioverter defibrillator

Chingping Wan et al. Ann Noninvasive Electrocardiol. 2014 May.

Abstract

Background: The survival outcome following a sudden cardiac arrest (SCA) in hemodialysis (HD) patients is poor regardless of whether an event takes place in or out of a dialysis center. The characteristics of SCA and post-SCA survival with HD patients using a wearable cardioverter defibrillator (WCD) are unknown.

Methods: All HD patients who were prescribed a WCD between 2004 and 2011 and experienced at least one SCA event were included in this study. Demographics, clinical background, characteristics of SCA events were identified from the manufacturer's database. An SCA event was defined as all sustained ventricular tachycardia/fibrillation (VT/VF) or asystole occurring within 24 hours of the index arrhythmia episode. The social security death index was used to determine mortality after WCD use.

Results: A total of 75 HD patients (mean age = 62.9 ± 11.7 years, female = 37.3%) experienced 84 SCA events (119 arrhythmia episodes) while wearing the WCD. Sixty six (78.6%) SCA events were due to VT/VF and 18 (21.4%) were due to asystole. Most SCA episodes occurred between 09:00 and 10:00 (RR = 2.82, 95% CI [1.05, 7.62], P < 0.0001), followed by the 13:00-14:00 time interval (RR = 2.22, 95% CI [0.79, 6.21], P = 0.006). Acute 24-hour survival was 70.7% for all SCA events; 30-day and 1-year survival were 50.7% and 31.4%, respectively. Women had a better post-SCA survival than men (HR = 2.41, 95% CI [1.09, 5.36], P = 0.03).

Conclusions: The use of WCD in HD patients was associated with improved post-SCA survival when compared to historical data.

Keywords: ESRD; hemodialysis hazards; mortality; sudden cardiac arrest; wearable cardioverter defibrillator.

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Figures

Figure 1
Figure 1
Example tracing for one VT/VF arrest (A) and one asystole event (B). VT = ventricular tachycardia; VF = ventricular fibrillation.
Figure 2
Figure 2
Timing of arrhythmia episodes by hour of the day (N = 119) (A). Timing of arrhythmia episodes by temporal clustering (N = 119) (B). Timing of arrhythmia episodes by day of the week (N = 119) (C).
Figure 3
Figure 3
Kaplan–Meier survival curve.
Figure 4
Figure 4
Survival curve (A) and hazard function (B) by gender.
See this image and copyright information in PMC

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