Management of sudden cardiac death in cardiac sarcoidosis using the wearable cardioverter defibrillator

PLoS One. 2018 Mar 22;13(3):e0194496. doi: 10.1371/journal.pone.0194496. eCollection 2018.

Abstract

Background: Patients with cardiac sarcoidosis are at increased risk of ventricular tachycardia/fibrillation.

Objective: We tested the hypothesis that the wearable cardioverter defibrillator can be used to mitigate the risk of sudden cardiac death among cardiac sarcoidosis patients.

Methods: A retrospective review of the commercial database identified cardiac sarcoidosis patients who wore the wearable cardioverter defibrillator. Evidence for cardiac sarcoidosis diagnosis as well as demographic, co-morbidity and left ventricular ejection fraction were provided by patient clinical records. Clinical data also included daily wearable cardioverter defibrillator wear, shock treatment and survival information.

Results: The wearable cardioverter defibrillator was worn by 46 cardiac sarcoidosis patients, 24 (52%) male. The median age was 48 years and median left ventricular ejection fraction was 30%. The wearable cardioverter defibrillator was worn a median of 23.6 hours each day. There were 11 ventricular tachycardia/fibrillation episodes occurring in 10 (22%) patients. Ventricular tachycardia/fibrillation occurred over a range of 1 to 79 days, median 24 days. First-shock success for conversion of ventricular tachycardia/fibrillation was 100%. Patient survival 24 hours after shock treatment was 100%. Follow up to determine the reason for discontinuing wearable cardioverter defibrillator use indicated that among shocked patients 7 received an implantable cardioverter defibrillator, 1 patient was admitted to the hospital ending in death 2 weeks after discontinuing wearable cardioverter defibrillator use, and 2 patients were lost to follow up. Among the not shocked patients, there were 16 who received an implantable cardioverter defibrillator while 7 achieved improved left ventricular ejection fraction.

Conclusion: Management of sudden cardiac death among cardiac sarcoidosis patients was aided by the wearable cardioverter defibrillator resulting in successful termination of ventricular tachycardia/fibrillation upon delivery of shock.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiomyopathies / complications
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / therapy*
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators / statistics & numerical data
  • Electric Countershock / instrumentation*
  • Electric Countershock / methods
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sarcoidosis / complications
  • Sarcoidosis / diagnosis
  • Sarcoidosis / therapy*
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / therapy
  • Ventricular Fibrillation / diagnosis
  • Ventricular Fibrillation / etiology
  • Ventricular Fibrillation / mortality
  • Ventricular Fibrillation / therapy
  • Wearable Electronic Devices / statistics & numerical data*

Grants and funding

The present registry is supported by an unrestricted grant from ZOLL. Steve Ringquist is an employee of ZOLL. The funder provided support in the form of salaries for author SR, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of this author are articulated in the ‘author contributions’ section.