Wearable ICD an option before implantation

The recent emergence of the wearable cardioverter-defibrillator provides a new prophylactic strategy for patients who are at significant risk for ventricular tachyarrhythmias (VT) or ventricular fibrillation (VF) but are not immediate candidates for implantable cardioverter-defibrillator (ICD) implantation, according to a review¹ published recently in Circulation.

The invasive nature of ICD procedure, cost issues, and potential complications related to an in-dwelling intravascular device (eg, inappropriate shocks, infection, thrombosis) have limited the use of ICD therapy to patients whose risk of sudden cardiac death is considered to be both very high and permanent, the authors say.

Consequently, patients undergoing diagnostic workups for underlying causes of VT/VF or those with reversible causes of sudden death frequently remain unprotected against cardiac arrest for time periods of variable duration, they claim. Similarly, patients awaiting ICD implantation and those with contraindications to implantation may also go unprotected for significant time periods.

The patient population likely to derive the most benefit from the wearable defibrillator remains to be defined, say the authors, who review the evidence base and role of wearable defibrillator therapy and clinical indications for its use.

References

1. Adler A, Halkin A, Viskin S. New drugs and technologies – wearable cardioverter-defibrillators. Circulation 2013;127:854–60. http://dx.doi.org/10.1161/CIRCULATIONAHA.112.146530