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

Christian Kuehn; Stefan Ruemke; Philipp Rellecke; Artur Lichtenberg; Dominik Joskowiak; Christian Hagl; Mohamed Hassan; Rainer G Leyh; Stefan Erler; Jens Garbade; Sandra Eifert; Philippe Grieshaber; Andreas Boening; Torsten Doenst; Ilia Velichkov; Tomas Madej; Michael Knaut; Andreas Hain; Heiko Burger

doi:10.1093/ejcts/ezac086

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

Eur J Cardiothorac Surg. 2022 May 2;61(5):1031-1040. doi: 10.1093/ejcts/ezac086.

Authors

Christian Kuehn¹, Stefan Ruemke¹, Philipp Rellecke², Artur Lichtenberg², Dominik Joskowiak³, Christian Hagl³, Mohamed Hassan⁴, Rainer G Leyh⁴, Stefan Erler⁵, Jens Garbade⁶, Sandra Eifert⁷, Philippe Grieshaber⁸, Andreas Boening⁸, Torsten Doenst⁹, Ilia Velichkov⁹, Tomas Madej¹⁰, Michael Knaut¹⁰, Andreas Hain¹¹, Heiko Burger¹²

Affiliations

¹ Department of Cardiac-,Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
² Department for Cardiac Surgery, Heinrich-Heine-University, Duesseldorf, Germany.
³ Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany.
⁴ Department of Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
⁵ Department for Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
⁶ Department for Cardiothoracic Surgery, Klinikum Links der Weser, Bremen, Germany.
⁷ Department of Cardiac Surgery, University Hospital Leipzig, Heart Center Leipzig, Leipzig, Germany.
⁸ Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany.
⁹ Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany.
¹⁰ Department of Cardiac Surgery, Dresden Heart Centre, Carl Gustav Carus University of Dresden, Dresden, Germany.
¹¹ Department of Cardiology, Kerckhoff-Clinic Bad Nauheim, Bad Nauheim, Germany.
¹² Department of Cardiovascular Surgery, Kerckhoff-Clinic Bad Nauheim, Bad Nauheim, Germany.

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.

Publication types

Multicenter Study

MeSH terms

Aged
Cardiac Surgical Procedures* / adverse effects
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / prevention & control
Defibrillators, Implantable* / adverse effects
Female
Humans
Male
Retrospective Studies
Stroke Volume
Ventricular Function, Left
Wearable Electronic Devices*