Published online Apr 26, 2018. doi: 10.4330/wjc.v10.i4.21
Peer-review started: January 14, 2018
First decision: February 12, 2018
Revised: March 20, 2018
Accepted: April 1, 2018
Article in press: April 1, 2018
Published online: April 26, 2018
Processing time: 103 Days and 0.4 Hours
Outcomes in patients with asystole and severe bradycardic events is poor. The wearable cardioverter defibrillator (WCD) can deliver shocks to terminate ventricular tachycardia and fibrillation, and also alarms for asystole and severe bradycardia events which can alert bystanders to help.
Minimal data exists on whether WCD improves outcomes and survival in patients with asystole and severe bradycardia events.
This study aimed to examine whether WCD alarms for asystole improve patient outcomes and survival.
Retrospective analysis all asystole episodes documented in the WCD registry during the year of 2013 and examination of outcomes and survival.
There were 264 asystole episodes in 257 patients and 76% of these events were considered “serious”. Overall patient survival after asystole or severe bradycardia events was 42%, and survival after “serious” asystole events was 26%. Among acute survivors, 20% later died during WCD use. Of the 86 living patients at the end of WCD use period, 48 (56%) received ICD/pacemaker and 17 (20%) improved their condition.
While the current indication for WCDs in high-risk patients is to detect and treat ventricular arrhythmias, patients with reduced LVEF are also at increased risk of having severe bradycardic events. The WCD may improve survival in patients with severe bradycardic/asystolic episodes by alerting bystanders to notify emergency medical services and to perform early cardiopulmonary resuscitation, as well as to detect episodes leading to appropriate permanent device implantation.
Future large prospective studies examining outcomes of WCD for asystole and severe bradycardia events are necessary to confirm a survival benefit with the device.