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The Journaling of Lane 778

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Zoll's LifeVest Wearable Defibrillator

The LifeVest wearable defibrillator is the first and only wearable defibrillator for patients at high risk of sudden cardiac arrest (SCA). The authors noted that current guidelines do not address the routine use of WCDs such as the LifeVest® (Zoll Medical Corp., Chelmsford, MA, USA) in patients with syncope.” 1 While this is true, the authors ask us to take a common-sense approach appealing to the Bayes theorem and the pretest probability that the patient's recurrent symptomatic events were driven by a malignant arrhythmia despite a normal echo and no significant obstructive coronary disease at catheterization.
Previous research has shown the risk of mortality in low ejection fraction patients is highest in the first 90 days after a cardiac event, such as a heart attack or a new diagnosis of heart ZOLL LifeVest Wearable Defibrillator failure,” said UCSF Health cardiologist Byron Lee , MD, MAS, professor of medicine and the Reeves Endowed Chair in Arrhythmia Research at UCSF and study co-principal investigator.



June 26—Wearable cardioverter defibrillators - vest-like devices that deliver electric shocks to interrupt a dangerous heart rhythm - may be a safe and effective alternative to surgically implanted devices in children with ventricular heart rhythm disorders that put them at risk for sudden cardiac death, according to new research published in Circulation: Arrhythmia and Electrophysiology, an American Heart Association journal.
24. Clinical Experience With WCDs  United States between 2002 and 2006, a 3569 patients wore a WCD for at least 1 day (mean duration, 53±70 days)  Discontinuation 14%  Longer duration of use associated with higher rates of compliance  Indications for WCD use included ICD explantation (23%), ventricular arrhythmia before planned ICD implantation (16%), recent MI (16%), post- CABG status (9%), and recent diagnosis of cardiomyopathy with an LVEF ≤0.35 (28%) 24 Piccini JP, Allen LA, Kudenchuk PJ, Page RL, Patel MR, Turakhia MP. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death.

Death from any cause occurred in 3.1% of the participants in the device group and in 4.9% of those in the control group (relative risk, 0.64; 95% CI, 0.43 to 0.98; uncorrected P=0.04), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15).
When focusing only on studies that involved patients with ischaemic cardiomyopathy, they found the incidence of appropriate WCD therapy to be much lower in the VEST trial at only 1 per 100 people over 3 months (95% CI: 1.0 to 2.0) than in the observational studies, which had an incidence of 11 per 100 people over 3 months (95% CI: 11.0 to 20.0; I2=93%).

The reason for WCD discontinuation was categorised as: (1) implantation of an ICD, (2) improvement of EF obviating ICD implantation, (3) termination of risk stratification without an indication for ICD implantation, (4) comfort issues and patient choice and (5) other reasons.
Patients have sometimes reported that they find the device symbolic of their own vulnerability 33 Of course, such adverse emotions may occur in all patients facing the sudden news that they have a serious cardiovascular condition regardless of whether they are prescribed a WCD or some other therapy.

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