Features August 2016 Issue

Wearable Defibrillators Helpful for Patients Not Suited for ICDs

The American Heart Association issues an advisory for the use of these life-saving devices, highlighting their effectiveness as short-term solutions.

Wearable defibrillators are becoming more lightweight.

A wearable automatic defibrillator may be a very helpful alternative to implanted cardioverter defibrillators (ICDs) for a select group of patients with abnormal heart rhythms, according to the American Heart Association’s (AHA) first-ever advisory on wearable defibrillators.

The AHA says wearable defibrillators should be considered options for patients who need an ICD, but are not good candidates for ICD implantation.

For example, after coronary artery bypass grafting surgery or coronary artery stenting, a patient may experience a temporary heart rhythm abnormality (arrhythmia). An ICD may be appropriate, but the arrhythmia may resolve itself, making artificial rhythm control unnecessary.

Or, if you had an ICD, but it had to be removed due to an infection or other complication, you may need to heal and wait until a new ICD can be implanted.

“Wearable is only for temporary situations, before it is clear that a permanent is needed, or while an infection is clearing, or until an ICD that is broken is fixed,” says Bruce Wilkoff, MD, director of Cardiac Pacing and Tachyarrhythmia Devices at Cleveland Clinic.

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Pros and Cons

While wearable defibrillators can play an important, if temporary, role in treating arrhythmia patients, they are not without some downsides. Many patients find them uncomfortable and inconvenient. Biomedical researchers are working on making the next generation of wearable defibrillators smaller, lighter, and easier to use.

The devices are becoming more widely used, though they remain appropriate for a specific type of patient.

“Their use is growing, but not dramatically,” Dr. Wilkoff says. “The use is inconvenient if you need it long term.”

In general, though, wearable defibrillators are short-term solutions, sometimes by necessity. Medicare, for example, requires a 90-day waiting period before covering the implantation of an ICD after stenting. This is because there is often uncertainty whether an ICD is necessary. A diagnosis of heart failure, when the future function of the left ventricle is also uncertain, also requires a waiting period before an ICD is covered.

A wearable device can serve as “bridge therapy” during that period. Dr. Wilkoff says that while an ICD is more convenient, and provides a longer-term peace of mind, wearable defibrillators may be life-saving devices.

“Remember that this is temporary, but that it is still effective, and it is a good way to stay out of the hospital while waiting until you are ready for an ICD,” he says.

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