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Wearable cardioverter defibrillator compliance in children reduces risk for sudden cardiac death
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Children with ventricular arrhythmias who wore a cardioverter defibrillator were generally likely to comply with appropriate wear times and durations, according to a study published in Circulation: Arrhythmia and Electrophysiology.
“Our results, which stem from the largest study to date among children in the United States using wearable cardioverter defibrillators, suggest that these external devices can help save the lives of children who are, at the time, not good candidates for surgically implanted defibrillators because of their medical condition,” David Spar, MD, assistant professor of pediatrics at University of Cincinnati and pediatric electrophysiologist at Cincinnati Children’s Hospital, said in a press release.
Researchers assessed data from 455 children (median age, 15 years; 61% boys) who had a wearable cardioverter defibrillator that was prescribed by their physician. Patients wore the wearable cardioverter defibrillator (LifeVest, Zoll Medical) for at least 1 day from Dec. 31, 2010, to Sept. 14, 2016.
Data from the registry included indication for the wearable cardioverter defibrillator, demographic information, daily wear time, length of use in days, therapies provided, arrhythmias detected and reasons for device return.
Children were the categorized based on the reason for the wearable cardioverter defibrillator: implantable cardioverter defibrillator problem (n = 63) and non-ICD problem (n = 392). An ICD problem was defined as a child who previously had an ICD system that resulted in infection, lead or system failure or lead fracture.
Therapy for ventricular fibrillation or ventricular tachycardia was considered to be appropriate therapy, and successful therapy was the termination of either condition.
During the study, the median daily wear time of the wearable cardioverter defibrillator was 20.6 hours and the median days worn was 33 days.
Children in the ICD problem group wore their wearable cardioverter defibrillator for less time than the non-ICD problem group (26 days vs. 35 days; P < .05).
Those who died during the study (1.5%) were not wearing the wearable cardioverter defibrillator at the time of death. At least one shock treatment was administered to 1.8% of patients.
Of those who received appropriate therapy (1.3%), seven episodes of polymorphic ventricular tachycardia or ventricular fibrillation occurred with 13 total treatments that were delivered. These episodes were converted successfully, and all patients survived.
“Additional comprehensive clinical data is required to understand which patients are at risk and may benefit from [wearable cardioverter defibrillator] therapy,” Spar and colleagues wrote. – by Darlene Dobkowski
Disclosures: Spar reports no relevant financial disclosures. One author reports she is an employee of Zoll Medical.
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