Abstract：
OBJECTIVE: Wearable cardioverter defibrillator (WCD) can protect patients from sudden cardiac death due to ventricular tachyarrhythmias and serve as a bridge to decision of definite defibrillator implantation. The aim of this analysis from an international, multicenter WCD registry was to identify predictors of sustained ventricular tachycardia (VT) and/or ventricular fibrillation (VF) in this population.
METHODS: One thousand six hundred seventy-five patients with WCD were included in a multicenter registry from 9 European centers, with a median follow-up of 440 days (IQR 120-893). The primary study end point was the occurrence of sustained VT/VF.
RESULTS: Sustained VT was detected by WCD in 5.4% and VF in 0.9% of all patients. Of the 30.3% of patients receiving ICD implantation during follow-up, sustained VT was recorded in 9.3% and VF in 2.6%. Non-ischemic cardiomyopathy (HR 0.5, p < 0.001), and medication with angiotensin-converting enzyme inhibitors (HR 0.7, p = 0.027) and aldosterone antagonists (HR 0.7, p = 0.005) were associated with a significantly lower risk of VT/VF.
CONCLUSIONS: Patients who received WCD due to a transient increased risk of sudden cardiac death have a comparatively lower risk of VT/VF in the presence of non-ischemic cardiomyopathy. Of note, optimal medical treatment for heart failure not only results in an improvement in left ventricular ejection fraction but also in a reduction in the risk for VT/VF.
METHODS: One thousand six hundred seventy-five patients with WCD were included in a multicenter registry from 9 European centers, with a median follow-up of 440 days (IQR 120-893). The primary study end point was the occurrence of sustained VT/VF.
RESULTS: Sustained VT was detected by WCD in 5.4% and VF in 0.9% of all patients. Of the 30.3% of patients receiving ICD implantation during follow-up, sustained VT was recorded in 9.3% and VF in 2.6%. Non-ischemic cardiomyopathy (HR 0.5, p < 0.001), and medication with angiotensin-converting enzyme inhibitors (HR 0.7, p = 0.027) and aldosterone antagonists (HR 0.7, p = 0.005) were associated with a significantly lower risk of VT/VF.
CONCLUSIONS: Patients who received WCD due to a transient increased risk of sudden cardiac death have a comparatively lower risk of VT/VF in the presence of non-ischemic cardiomyopathy. Of note, optimal medical treatment for heart failure not only results in an improvement in left ventricular ejection fraction but also in a reduction in the risk for VT/VF.
摘要：
目的：可穿戴式心律转复除颤器（WCD）可以保护患者免受室性心动过速导致的心源性猝死，并作为确定除颤器植入的桥梁。这一分析的目的来自国际，多中心WCD注册旨在确定该人群中持续性室性心动过速（VT）和/或室颤（VF）的预测因子。
方法：来自9个欧洲中心的多中心注册表中包括了一千六百七十五名WCD患者，中位随访时间为440天（IQR120-893）。主要研究终点是持续VT/VF的发生。
结果：在所有患者中，通过WCD检测到的持续性室性心动过速为5.4%，VF为0.9%。在随访期间接受ICD植入的30.3%患者中，持续性室性心动过速为9.3%,VF为2.6%.非缺血性心肌病（HR0.5，p<0.001），血管紧张素转换酶抑制剂(HR0.7,p=0.027)和醛固酮拮抗剂(HR0.7,p=0.005)与VT/VF的风险显著降低相关.
结论：在非缺血性心肌病存在的情况下，因暂时性心源性猝死风险增加而接受WCD治疗的患者的VT/VF风险相对较低。值得注意的是，心力衰竭的最佳药物治疗不仅可以改善左心室射血分数,而且可以降低VT/VF的风险.
方法：来自9个欧洲中心的多中心注册表中包括了一千六百七十五名WCD患者，中位随访时间为440天（IQR120-893）。主要研究终点是持续VT/VF的发生。
结果：在所有患者中，通过WCD检测到的持续性室性心动过速为5.4%，VF为0.9%。在随访期间接受ICD植入的30.3%患者中，持续性室性心动过速为9.3%,VF为2.6%.非缺血性心肌病（HR0.5，p<0.001），血管紧张素转换酶抑制剂(HR0.7,p=0.027)和醛固酮拮抗剂(HR0.7,p=0.005)与VT/VF的风险显著降低相关.
结论：在非缺血性心肌病存在的情况下，因暂时性心源性猝死风险增加而接受WCD治疗的患者的VT/VF风险相对较低。值得注意的是，心力衰竭的最佳药物治疗不仅可以改善左心室射血分数,而且可以降低VT/VF的风险.
