Predictors of ventricular tachyarrhythmia in patients with a wearable cardioverter defibrillator: an international multicenter registry.

BACKGROUND AND AIMS: 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.

Real-world experience with the wearable cardioverter defibrillator: clinical effectiveness and wear-time adherence in patients at high risk for sudden cardiac death.

BACKGROUND: Previous studies established a role for the wearable cardioverter defibrillator (WCD) to effectively and safely bridge temporary risk for sudden cardiac death (SCD) in patients with advanced heart failure. The prognostic relevance of the WCD remains controversial. OBJECTIVES: The authors investigated adherence to, as well as the safety and effectiveness of, WCD use in a real-world cohort of patients at high risk for SCD. MATERIAL AND METHODS: All consecutive patients (n = 83) receiving a WCD at a German tertiary care hospital between April 2012 and December 2019 were retrospectively included in this analysis. Patient characteristics were collected at the time of the index hospitalization. Using the Zoll® lifeVest® (ZOLL Medical Corporation, Chelmsford, MA, USA) network database, two separate investigators evaluated adherence to the WCD as well as arrhythmic events during WCD wear time. RESULTS: During 3680 wearing days (mean WCD wear time, 44 days) with a median daily wear time of 23.1 h, three arrhythmic events of relevance (sustained ventricular tachycardia, VT) occurred, one of which was sufficiently terminated by WCD shock. Another patient died from sudden cardiac death while pausing his WCD. Right bundle branch block correlated significantly with sustained VT occurrence (r = 0.3315; 95% CI -0.1265 to 0.3014; p = 0.0022). In 30 patients (36.1%) a cardioverter/defibrillator was implanted. CONCLUSION: In a real-life clinical setting, the use of WCD in patients at high risk for sudden cardiac death is effective and safe and adherence to the device is high. The event rate for VA was lower than in comparable patient cohorts. Adherence remains a crucial issue as one patient in the present series died while not wearing the device.

The reproducibility of radiographic measurement of medial meniscus horn position.

PURPOSE: The objective of this investigation was to evaluate the possibility of locating and reproducing the tibial insertion areas of the anterior and posterior horns of the medial meniscus on preoperative radiographs according to an established method for the lateral meniscus. METHODS: In 20 tibia heads, we prepared anterior and posterior horn insertions and marked their circumference with radiopaque steel balls of 1.6 mm in diameter. Standardized anteroposterior and lateral radiographs were made. On these radiographs, different landmarks were defined, their distances measured (tibial width and depth, distance from lateral tibia border to meniscus insertion midpoint, distance from anterior tibia border to meniscus insertion midpoint, distance from anterior and lateral tibia border to medial intercondylar spine), and ratios determined. RESULTS: The anterior horn midpoint is located at 57.3% +/- 2.7% of tibial width and 12.0% +/- 1.0% of tibial depth, and the posterior horn midpoint is located at 56.5% +/- 1.6% of tibial width and 81.6% +/- 3.4% of tibial depth. The statistical analysis of these measures showed a precise and constant positioning of the medial meniscus insertions on the tibia plateau. We also found constant topographic relations to the medial intercondylar spine. CONCLUSIONS: The midpoints of both insertion areas of the medial meniscus have constant positions at 57.3% and 56.5% of tibial width and at 12.0% and 81.6% of tibial depth for the anterior and posterior horn, respectively. They can precisely and reproducibly be defined on radiographs. CLINICAL RELEVANCE: We have developed a technique for precise radiographic tibial horn determination, exact placement of the tibial tunnels, and thus reconstruction of meniscus insertion anatomy in medial meniscus transplantation.