Objectives: Patients undergoing cardiac surgery procedures like CABG, valve replacement or reconstruction
or CIED extraction and coexisting severe reduced left ventricular ejection fraction
(EF < 35%) are at high risk of developing ventricular arrhythmias (VA). Therefore,
the position paper of the working group on cardiac arrhythmias of the German Society
for Thoracic and Cardiovascular Surgery recommends the prophylactic use of a wearable
cardioverter defibrillator vest (WCD) for transient prevention of sudden cardiac death
(SCD) in this patient cohort. This study aimed to analyze the incidence of postoperative
VA and the role of WCD after cardiac surgery.
Methods: In this multicenter study, we retrospectively analyzed all surgical patients who
were discharged with a WCD. The WCD was prescribed for patients with a postoperative
persistence of a reduced left ventricular ejection fraction (LVEF) of £35% or after
extraction of an indicated ICD. The clinical data were obtained from the institutions
medical records. WCD-wearing time, VA, and WCD shocks were analyzed provided by the
automatically recorded WCD’s ECG.
Results: A total of 1,132 patients were included. Mean age was 64.4 years, and 959 (84.7%)
patients were male. Overall wearing time was 21.2 hours per day. Sixty (5.3%) patients
experienced VA: 17 (1.5%) patients had ventricular fibrillation (VF) and were successfully
defibrillated by the WCD. Further 43 (3.8%) patients experienced nonsustained ventricular
tachycardias. No patient died while wearing the WCD. Three patients were shocked inadequately
due to wrong alarm rejection.
Conclusion: The compliance of our patients was very high (21.2 hours/day), despite of sternotomy.
Cardiac surgery patients with severely reduced pump function or explanted ICD were
at high risk for malignant arrhythmias: 1.4% of patients were successfully defibrillated
for VF and 5.3% experienced ventricular arrhythmias. WCD is feasible and can effectively
protect patients of SCD after cardiac surgery.
