From the Guidelines
Life vests are recommended for patients with non-ischemic cardiomyopathy who are at high risk for sudden cardiac death but are not immediate candidates for an implantable cardioverter-defibrillator (ICD). The wearable cardioverter-defibrillator (WCD) or "life vest" should be considered for patients with newly diagnosed non-ischemic cardiomyopathy with severely reduced left ventricular ejection fraction (LVEF ≤35%) during the initial optimization of medical therapy, which typically takes 3-6 months 1.
Key Considerations
- The life vest provides protection while determining if the patient's heart function will improve with medication or if they will ultimately need a permanent ICD.
- The device is worn continuously except during bathing, with the sensing electrodes maintaining contact with the skin to detect dangerous arrhythmias.
- If ventricular tachycardia or fibrillation is detected, the device delivers a shock to restore normal rhythm.
- Patient compliance is crucial for effectiveness, and proper skin care under the electrodes is important to prevent irritation.
- The life vest serves as a bridge therapy, offering protection during the waiting period when patients are vulnerable but may not yet need permanent device implantation.
Clinical Evidence
- The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) enrolled 2521 patients with non-ischaemic dilated cardiomyopathy or ischaemic HF, no prior symptomatic ventricular arrhythmia, and an EF ≤35% who were in NYHA functional class II or III 1.
- ICD treatment led to an RRR in death of 23% (P = 0.007) over a median follow-up of 45.5 months.
- ICD implantation should be considered only after a sufficient period of optimization of medical therapy (at least 3 months) and only if the EF remains persistently low 1.
Recommendations
- Life vests should be considered for patients with non-ischemic cardiomyopathy and LVEF ≤35% during the initial optimization of medical therapy.
- The life vest should be worn continuously except during bathing, and patient compliance is crucial for effectiveness.
- Proper skin care under the electrodes is important to prevent irritation.
From the Research
Role of Life Vest in Non-Ischemic Cardiomyopathy
- The provided studies do not directly mention the role of a life vest in non-ischemic cardiomyopathy.
- However, they discuss the use of implantable cardioverter-defibrillators (ICDs) and wearable cardioverter-defibrillators (WCDs) in patients with nonischemic cardiomyopathy [ 2, 3, 4, 5, 6 ].
- These devices are used to prevent sudden cardiac death (SCD) in patients with nonischemic cardiomyopathy, particularly those with severely reduced left ventricular ejection fraction [ 5, 6 ].
- The studies suggest that ICDs and WCDs can be effective in reducing the risk of SCD in patients with nonischemic cardiomyopathy [ 4, 6 ].
- However, the evidence for the survival benefit of primary prevention ICDs in patients with high-risk nonischemic cardiomyopathy is not robust [ 2, 3 ].
Risk Stratification and Prevention of SCD
- The studies emphasize the importance of risk stratification in identifying patients with nonischemic cardiomyopathy who are at high risk of SCD [ 2, 3, 4 ].
- They discuss the use of various tools, including cardiac magnetic resonance imaging and computational modeling, to improve risk stratification and guide clinical decision-making [ 2, 3 ].
- The studies also highlight the need for precise risk stratification algorithms to define those at the highest risk of SCD [ 2 ].