Wearable Cardioverter Defibrillator (WCD) after Cardiac Surgery

Background: Patients with left ventricular ejection fraction (LVEF) < 35% are at high risk of sudden cardiac death (SCD) and benefit from implantable cardioverter-defibrillator (ICD) therapy. ICD implantation is not favorable during the first 40 days after acute myocardial infarction and < 3 months after coronary artery bypass grafting because of the chances of cardiac recovery. The cardioverter defibrillator jacket is a therapy option for preventing sudden cardiac death in this bridging phase and as distention therapy in case of myocardium recovery. This study evaluated the effectiveness of cardioverter-defibrillator jacket after cardiac surgery.

Method: This is a retrospective study conducted in the Heart Center of Erlangen from 2018 to 2021. Forty-eight patients who had wearable cardioverter-defibrillator (WCD) were retrospectively analyzed and followed up. Patient's demographics, defibrillation treatments, and periods of wearing the jacket through the day for every patient were retrospectively obtained from the manufacturer company database. The patients were examined if they had to get implanted ICD at the end of the follow-up after therapy.

Results: Forty-eight patients (mean age: 64) (92% men and 8% women) were treated with a WCD in response to heart failure (mean EF: 26%) after cardiac surgery (ICM: 44 patients, NICM: 4 patients).

Average daily use of a WCD was 22.2 hours in a day per patient which were worn for average 61 days. At that time, a median of 7 events were detected but not treated, 2 defibrillations performed, and no asystole seen. After a follow-up of 3 months, patients asked to come to our outpatient clinic for a new evaluation of cardiac myocardial function based on clinical examination and echocardiography assessment of the ejection fraction. At the end of the follow-up all patients were alive. 57% (n = 27) of the patients showed recovery of the ejection fraction and had a freedom from implantation of an ICD. 31% (n = 15) of the patients have to be admitted from implantation of an ICD, 12% (n = 6) of the patients are lost in follow-up.

Conclusion: A wearable cardioverter defibrillator is an effective alternative for prevention of sudden cardiac death during myocardium recovery period after a cardiac Surgery. It is worth knowing that defibrillator jacket can save health care system resources when it used as a bridging therapy until the cardiac function recovered. Health care providers must know that this treatment required a high patient compliance.

Publication History

Article published online:
03 February 2022