RESUMO
BACKGROUND: The survival outcome following a sudden cardiac arrest (SCA) in hemodialysis (HD) patients is poor regardless of whether an event takes place in or out of a dialysis center. The characteristics of SCA and post-SCA survival with HD patients using a wearable cardioverter defibrillator (WCD) are unknown. METHODS: All HD patients who were prescribed a WCD between 2004 and 2011 and experienced at least one SCA event were included in this study. Demographics, clinical background, characteristics of SCA events were identified from the manufacturer's database. An SCA event was defined as all sustained ventricular tachycardia/fibrillation (VT/VF) or asystole occurring within 24 hours of the index arrhythmia episode. The social security death index was used to determine mortality after WCD use. RESULTS: A total of 75 HD patients (mean age = 62.9 ± 11.7 years, female = 37.3%) experienced 84 SCA events (119 arrhythmia episodes) while wearing the WCD. Sixty six (78.6%) SCA events were due to VT/VF and 18 (21.4%) were due to asystole. Most SCA episodes occurred between 09:00 and 10:00 (RR = 2.82, 95% CI [1.05, 7.62], P < 0.0001), followed by the 13:00-14:00 time interval (RR = 2.22, 95% CI [0.79, 6.21], P = 0.006). Acute 24-hour survival was 70.7% for all SCA events; 30-day and 1-year survival were 50.7% and 31.4%, respectively. Women had a better post-SCA survival than men (HR = 2.41, 95% CI [1.09, 5.36], P = 0.03). CONCLUSIONS: The use of WCD in HD patients was associated with improved post-SCA survival when compared to historical data.
Assuntos
Morte Súbita Cardíaca/epidemiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
Congenital disorders, such as dextrocardia and persistent left superior vena cava, are rare. However, their presence is often associated with other cardiac anomalies, and may lead to lethal ventricular tachyarrhythmias, which result in sudden cardiac death. Treating patients with these disorders can present a challenge to clinicians, as it may cause technical difficulties during interventional procedures, and more often, altered defibrillation techniques in a setting of prehospital sudden cardiac arrest. This report describes the first case of successful defibrillation therapy delivered by the wearable cardioverter defibrillator to a patient with dextrocardia and persistent left superior vena cava during a ventricular tachycardia arrest.