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. 2022 Sep-Oct;22(5):217-222.
doi: 10.1016/j.ipej.2022.06.005. Epub 2022 Jun 28.

Wearable cardioverter-defibrillator (life-vest): A feasible bridging treatment in adult congenital heart disease

Berardo Sarubbi  1 , Michela Palma  2 , Assunta Merola  2 , Flavia Fusco  2 , Anna Correra  2 , Diego Colonna  2 , Emanuele Romeo  2 , Nicola Grimaldi  2 , Giovanni Domenico Ciriello  2 , Giancarlo Scognamiglio  2 , Maria Giovanna Russo  3
Affiliations

Wearable cardioverter-defibrillator (life-vest): A feasible bridging treatment in adult congenital heart disease

Berardo Sarubbi et al. Indian Pacing Electrophysiol J. 2022 Sep-Oct.

Abstract

Background: Wearable cardioverter-defibrillators (WCDs) are currently used in patients at temporarily heightened risk for sudden cardiac death (SCD) who are temporarily unable to receive an implantable cardioverter-defibrillator (ICD). WCD can safely record and terminate life-threatening arrhythmias through a non-invasive electrode-based system. The current clinical indications for WCD use are varied and keep evolving as experience with this technology increases.

Methods: We reviewed and explored the data behind indications for WCD use and discuss its usefulness in congenital heart disease (CHD) patients.

Results: We considered 8 consecutive patients (mean age 35.25 years, range 18-51 years, average duration of WCD use 4 months, range 3-6 months) with complex CHD, in which a WCD was used between June 2018 and January 2022. No sustained ventricular arrhythmias requiring shocks were recorded in the observation period. No inappropriate shocks were recorded. All the patients showed a good compliance and a very high mean wear time per day (21.2 ± 1 h a day). Four patients implanted a permanent device (3 CRT-D, 1 ICD), three underwent cardiac surgery at the end of the WCD period and one is still on the waiting list for the operation.

Conclusions: Larger trial could confirm the possible conceivable benefit from an extended use of the WCD in certain populations with complex CHD as in our case series, especially in patients with life-treating ventricular arrhythmias waiting for surgery for residual cardiac defects or in the early phases following the surgical/hemodynamic interventions, patients with tachycardiomyopathy expected to improve after the arrhythmias are removed and patients awaiting implantation of an ICD at high risk due to active infection.

Keywords: Congenital heart disease; Quality of life; Sudden death; Ventricular arrhythmias; Wearable cardioverter defibrillator.

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Conflict of interest statement

Declaration of competing interest No funding sources have been given for this study. All authors report no relationships that could be construed as a conflict of interest.

Figures

Fig. 1
Fig. 1
Wearable Cardioverter Defibrillator (WCD) and Monitor Unit. Patient A.M. Case n°2.
Fig. 2
Fig. 2
Clinical case n 3. Patient D.Z. Fig. 2A: Echocardiographic evidence of severe pulmonary regurgitation Fig. 2B: Telemetric electrocardiography showing non-sustained VT run.
Fig. 3
Fig. 3
Clinical case n.1. Patient C.D.G. Fig. 3A: High-rate supraventricular tachycardia (intra-atrial reentry tachycardia as confirmed through electrophysiological study) Fig. 3B: Echocardiographic evidence of dilated left ventricle.
Fig. 4
Fig. 4
Clinical case n 2. Patient A.M. Fig. 4A Echocardiographic evidence of a vegetation of 0.9 × 0.9 mm attached to the atrial side of the stenotic mitral valve. Fig. 4B: severe biventricular function depression (LVEF 17%).
See this image and copyright information in PMC

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