PDF(Pubmed)
Abstract：
The wearable cardioverter defibrillator (WCD) is becoming a more and more widely used instrument for the prevention of sudden cardiac death of patients either with a secondary prevention implantable cardioverter defibrillator indication or with a transient high risk of sudden cardiac death. Although clinical practice has demonstrated a benefit of protecting patients for a period as long as 3-6 months with such devices, the current European guidelines concerning ventricular arrhythmias and sudden cardiac death are still extremely restrictive in the patient selection in part because of the costs derived from such a prevention device, in part because of the lack of robust randomised trials.To illustrate expanded use cases for the WCD, four real-life clinical cases are presented where patients received the device slightly outside the established guidelines. These cases demonstrate the broader utility of WCDs in situations involving acute myocarditis, thyrotoxicosis, pre-excited atrial fibrillation and awaiting staging/prognosis of a lung tumour. The findings prompt expansion of the existing guidelines for WCD use to efficiently protect more patients whose risk of arrhythmic cardiac death is transient or uncertain. This could be achieved by establishing a European register of the patients who receive a WCD for further analysis.
摘要：
可穿戴心律转复除颤器（WCD）正在成为一种越来越广泛使用的仪器，用于预防具有二级预防可植入心律转复除颤器适应症或具有短暂的高心源性猝死风险的患者的心源性猝死。尽管临床实践已证明使用此类设备可以在长达3-6个月的时间内保护患者，目前关于室性心律失常和心源性猝死的欧洲指南在患者选择方面仍然非常严格，部分原因是这种预防装置产生的成本。部分原因是缺乏强有力的随机试验。为了说明WCD的扩展用例，4例真实的临床病例中,患者接受的装置稍超出既定指南.这些病例证明了WCD在涉及急性心肌炎的情况下具有更广泛的实用性，甲状腺毒症,预激心房颤动，等待肺部肿瘤的分期/预后。这些发现促使现有WCD使用指南的扩展，以有效保护更多心律失常性心脏死亡风险短暂或不确定的患者。这可以通过建立接受WCD进行进一步分析的患者的欧洲登记册来实现。
