Aritmologia in Campania

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Wearable Cardioverter-Defibrillators

Arnon Adler, Amir Halkin and Sami Viskin

Since its introduction >3 decades ago, the implantable cardioverter-defibrillator
(ICD) has been used extensively to
enhance the survival of patients at high risk for sudden cardiac
death resulting from life-threatening ventricular tachyarrhythmias
(VTs; ie, sustained VT and ventricular fibrillation
[VF]).1,2 Nevertheless, the invasive nature of the implantation
procedure, cost issues, and potential complications related to
an in-dwelling intravascular device (eg, inappropriate shocks,
infection, thrombosis) have limited the use of ICD therapy
to patients whose risk of sudden cardiac death is considered
to be both very high and permanent. Consequently, patients
undergoing diagnostic workups for underlying causes of VT/
VF or those with reversible causes of sudden death frequently
remain unprotected against cardiac arrest for time periods of
variable duration. Similarly, patients awaiting ICD implantation
and those with contraindications to implantation may
also go unprotected for significant time periods. The recent
emergence of the wearable cardioverter-defibrillator provides
a new prophylactic strategy for patients who are at significant
risk for VT/VF but are not immediate candidates for ICD
implantation. The patient population who is likely to derive
the most benefit from the wearable defibrillator remains to be
defined. We provide an in-depth review of the evidence base
and role of wearable defibrillator therapy and clinical indications
for its use.

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