P1682WCD-Utilisation in heart-failure-patients with reduced EF (<35%) during waiting time for SCD-risk assessment -Recovery depending on age and baseline ejection fraction-

Abstract

Introduction: Whilst a reduced ejection fraction (EF) is clearly an indication for the implantation of an ICD, the results of randomized trials and current guidelines demand a waiting period in which the patient might recover and is no longer indicated for an ICD. During this period of Guideline directed medial therapy (GDMT) the patient is at high risk for sudden cardiac death (SCD). The wearable cardioverter defibrillator (WCD) allows us to discharge those patients knowing that they will be protected by a noninvasive, reversible method. The correlation between such parameters as patient age or the baseline EF, and the rate of recovery is still unclear. Methodology: Based on the recommendations of the HRS and the screening protocol of our institution we prescribed a WCD for every patient with an EF of 35% and lower. During the period GDMT patients were monitored by the deviceown telemonitoring system. Reevaluation was initiated after a period of 10‐12 weeks, to determine the necessity for ICD/CRT‐D implantation. Patients were divided in an ICM and NICM group. Age, ejection fraction upon admission and after three momnths were analysed. Results: 116 Patients with LVEF<35% have been fitted with the wearable cardioverter defibrillator. The median weartime was 23,4 h/d SD ± 3,7. In the total cohort 51 pts (44%) did not show EF improvement above (≤35%), hence the decision was made to implant an ICD/CRT‐D. The patients showed an age‐dependent improvement of ejection fraction. All patients aged 30‐44 years showed improvement in ejection fraction >35%. Despite the fact that in the older population the recovery is lower, still 38% of patients aged between 75 and 89 years experienced recovery and did not need an ICD/CRTD. The older the patients, the more unlikely was a recovery to an EF >35%. A correlation between baseline EF and recovery rate could not be shown. Summary: The usage of the wearable cardioverter defibrillator supported in determining candidates for an ICD. When patients were reevaluated a significant number did not need an ICD after the waiting period due to significant improvement of the ejection fraction. Data show a clear age‐dependent improvement in ejection fraction. A dependency on baseline EF could not be shown. (Figure Presented).