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Multicenter Study
. 2022 May 2;61(5):1031-1040.
doi: 10.1093/ejcts/ezac086.

Wearable cardioverter defibrillator multicentre experience in a large cardiac surgery cohort at transient risk of sudden cardiac death

Christian Kuehn  1 , Stefan Ruemke  1 , Philipp Rellecke  2 , Artur Lichtenberg  2 , Dominik Joskowiak  3 , Christian Hagl  3 , Mohamed Hassan  4 , Rainer G Leyh  4 , Stefan Erler  5 , Jens Garbade  6 , Sandra Eifert  7 , Philippe Grieshaber  8 , Andreas Boening  8 , Torsten Doenst  9 , Ilia Velichkov  9 , Tomas Madej  10 , Michael Knaut  10 , Andreas Hain  11 , Heiko Burger  12
Affiliations
Multicenter Study

Wearable cardioverter defibrillator multicentre experience in a large cardiac surgery cohort at transient risk of sudden cardiac death

Christian Kuehn et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: The wearable cardioverter defibrillator (WCD) is an established, safe, effective solution, protecting patients at risk of sudden cardiac death. We specifically investigated WCD use in cardiac surgery patients since data for this patient group are rare.

Methods: Retrospective data analysis in 10 German cardiac surgery centres was performed. Cardiac surgery patients with left ventricular ejection fraction (LVEF) ≤35% or after implantable cardioverter defibrillator (ICD) explantation who received WCD between 2010 and 2020 were assessed using LifeVest Network data.

Results: A total of 1168 patients with a median age of 66 years [interquartile range (IQR) 57-73] were enrolled; 87% were male. Clinical indications included coronary artery bypass grafting (43%), valve surgery (16%), combined coronary artery bypass graft/valve surgery (15%), ICD explantation (24%) and miscellaneous (2%). The median wear time of WCD was 23.4 h/day (IQR 21.7-23.8). A total of 106 patients (9.1%) exhibited ventricular tachycardia. A total of 93.2% of episodes occurred within the first 3 months. Eighteen patients (1.5%) received 26 adequate shocks. The inadequate shock rate was low (8 patients, 0.7%). LVEF improved from a median of 28% (IQR 22-32%) before WCD prescription to 35% (IQR 28-42%) during follow-up. Excluding ICD explant patients, 37% of patients received an ICD.

Conclusions: The risk of sudden cardiac death is substantial within the first 3 months after cardiac surgery. Patients were protected effectively by WCD. Due to significant LVEF improvement, the majority did not require ICD implantation after WCD use. Compliance was high despite sternotomy. This multicentre experience confirms existing data regarding effectiveness, safety and compliance. Therefore, WCD should be considered in cardiac surgery patients with severely reduced LVEF.

Keywords: Cardiac surgery; Heart failure; Postoperative mortality; Sudden cardiac death; Ventricular arrhythmia; Wearable cardioverter defibrillator.

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Figures

Figure 1:
Figure 1:
The prevalence of ventricular tachycardia/ventricular fibrillation episodes in relation to the time of surgical intervention.
Figure 2:
Figure 2:
Probability of wearable cardioverter defibrillator shock depending on the surgical method.
Figure 3:
Figure 3:
(A) Estimated survival probability without wearable cardioverter defibrillator per procedure. The vertical axis was cut for better readability of the data curves. (B) Estimated survival probability without wearable cardioverter defibrillator of implantable cardioverter defibrillator explant patients versus all other patients. The vertical axis was cut for better readability of the data curves.
Figure 3:
Figure 3:
Continued
Figure 4:
Figure 4:
(A) Left ventricular ejection fraction development per surgical procedure. Shown are medians previous to surgery, at discharge, and at end of wearable cardioverter defibrillator use. (B) Box plots. Left ventricular ejection fraction differences from discharge (0) to end of wearable cardioverter defibrillator use per procedure.
None
See this image and copyright information in PMC

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