Wearable DefibrillatorZOLL Medical Corporation, a manufacturer of resuscitation devices and related software solutions, announced that the ZOLL LifeVest® Wearable Defibrillator is now covered by Medical Assistance (MA), Minnesota's Medicaid program. The WCD (LifeVest®, ZOLL, Pittsburgh, PA) was FDA-approved in 2001 as an outpatient device after a clinical trial involving 285 out-of-hospital patients 16 WCDs are intended for use in adult patients that have an increased risk of SCD if an ICD is not warranted.
While I think that single-chamber ICDs are often preferred—especially in primary-prevention settings without pacing indications—in this patient who was already on escalating ZOLL LifeVest Wearable Defibrillator doses of antiarrhythmic medication, it might prove prudent to have the ability to pace the atrium in case there is spontaneous or drug-induced bradycardia.
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).
In this issue of The Journal of Innovations in Cardiac Rhythm Management, Johnston et al. 1 present an interesting case of a middle-aged, healthy, fit, physically active woman with recurrent syncope who was managed within the context of an initially largely negative workup at a community hospital followed by discharge and subsequent referral to a tertiary care facility for further diagnostic testing and therapy.
In addition, in this embodiment, the method includes determining if the patient is in ventricular tachycardia (VT), ventricular fibrillation (VF), or atrial fibrillation (AF), and establishing at least a second electrical path if VF or AF is determined The step of establishing at least a second electrical patent comprises attaching at least one additional electrode to the thorax of the patient to establish at least one additional electrical path across the thoracic cavity and through the heart of the patient.
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%).
However, in an as-treated analysis, a significantly lower percentage of patients died when they were wearing the wearable cardioverter-defibrillator than when they were not, a finding that remained significant even after the most conservative correction for multiple comparisons.
It was designed to test whether this device could effectively reduce sudden death in patients who had recently suffered a heart attack and had reduced heart function (defined as a low ejection fraction of 35 percent or less) where the heart wasn't able to pump sufficient blood to the rest of the body, which is indicative of a sizable heart attack.