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Wearable cardioverter-defibrillator after myocardial infarction

New England Journal of Medicine, ISSN: 1533-4406, Vol: 379, Issue: 13, Page: 1205-1215
2018
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Der plötzliche Herztod ist ein im Vorhinein oft nicht erkennbarer Todesfall, der häufig auf das Auftreten lebensbedrohlicher Herzrhythmusstörungen zurückzuführen ist.

Plötzlicher Herztod und Herzrhythmus-Störungen: Begrenzte Sinnhaftigkeit der Defi-Weste. Risikostratifikation und das Definieren adäquater Therapien sind schwierig, berichtet Prof. Dr. Thomas Deneke (Bad Neustadt), Sprecher der Arbeitsgruppe Rhythmologie der DGK anlässlich der Deutschen Herztage in Berlin.

Article Description

BACKGROUND Despite the high rate of sudden death after myocardial infarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardial infarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear. METHODS We randomly assigned (in a 2:1 ratio) patients with acute myocardial infarction and an ejection fraction of 35% or less to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (the device group) or to receive only guideline-directed therapy (the control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. RESULTS Of 2302 participants, 1524 were randomly assigned to the device group and 778 to the control group. Participants in the device group wore the device for a median of 18.0 hours per day (interquartile range, 3.8 to 22.7). Arrhythmic death occurred in 1.6% of the participants in the device group and in 2.4% of those in the control group (relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P = 0.18). 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). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock. CONCLUSIONS Among patients with a recent myocardial infarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly lower rate of the primary outcome of arrhythmic death than control.

Bibliographic Details

Olgin, Jeffrey E; Pletcher, Mark J; Vittinghoff, Eric; Wranicz, Jerzy; Malik, Rajesh; Morin, Daniel P; Zweibel, Steven; Buxton, Alfred E; Elayi, Claude S; Chung, Eugene H; Rashba, Eric; Borggrefe, Martin; Hue, Trisha F; Maguire, Carol; Lin, Feng; Simon, Joel A; Hulley, Stephen; Lee, Byron K; VEST Investigators

Massachusetts Medical Society

Medicine

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