Abstract 952 The use of Wearable cardioverter defibrillator among patients suffering from myocarditis: data from a multicenter Registry

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
The use of Wearable cardioverter defibrillator among patients suffering from myocarditis: data from a multicenter Registry
I. El-Battrawy¹, K. Koepsel¹, B. Kovacs², T. Dreher³, C. Blockhaus⁴, M. Gotzmann⁵, N. Klein⁶, D.-I. Shin⁴, M. Abumayyaleh³, H. Lapp⁷, A. Saguner², J. W. Erath-Honold⁸, F. Duru², A. Mügge⁹, A. Aweimer¹, I. Akin³, T. Beiert⁷
¹Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil, Bochum; ²UniversitätsSpital Zürich, Zürich; ³I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; ⁴Medizinische Klinik I, HELIOS Klinikum Krefeld, Krefeld; ⁵Kardiologie und Rhytmologie, Kath. Klinikum Bochum, Bochum; ⁶Klinik für Kardiologie, Angiologie und intern. Intensivmedizin, Klinikum Sankt Georg, Leipzig; ⁷Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ⁸Med. Klinik III - Kardiologie, Angiologie, Universitätsklinikum Frankfurt, Frankfurt am Main; ⁹Medizinische Klinik II, Kardiologie, Klinikum der Ruhr-Universität Bochum, Bochum;
Background Data on the use of the wearable cardioverter defibrillator (WCD) among patients suffering from myocarditis in a large cohort remains sparse. Subsequently several guidelines give a different recommendation regarding WCD indication in this cohort. Methods 1596 patients were included in a multicenter registry from eight European centers. Among this cohort 132 (8%) patients received a WCD due to myocarditis. The mean follow-up time of the whole cohort was 620.2±607.8 days. The presence of ventricular tachyarrhythmias and/or WCD shocks during WCD use were evaluated. Results The mean age of patients was 52.5±16.3 years (75% males). 20% of patients suffered from atrial fibrillation, 17% diabetes mellitus, 40% were smoker and 38.9% suffered from arterial hypertension. The body-mass-index (BMI) of the cohort was 27.8±5.7 kg/m². The initial left ventricular ejection fraction (LVEF) was 33.4±14.6% and increased to 45.9±13.2% (p<0.05) over long-term follow-up. Patient were discharged on ACE-inhibitors (62.5%), ARNI (21.2%), aldosterone-antagonist (50%), beta-blockers (89.5%) and amiodarone (13.6%). An improvement of LVEF (LVEF>35%) was documented in 81.2% of patients. The BNP level was at baseline 7401±30584 pg/ml and decreased to 530±803 pg/ml (p<0.05) over long-term follow-up. The wear duration was 78.5±51.5 days and 34% of patients wore the WCD for longer than 90 days. The wear-hours per day were 21.1±4.8 hours. In 3.1% sustained ventricular tachycardia, 0.8% ventricular fibrillation and 9.1% non-sustained ventricular tachycardia were documented. Subsequently 3% of patients suffered from an appropriate WCD shock. The rate of inappropriate WCD shock was 0.8%. Patients suffering from WCD shock were at age 31, 31, 61, 24 and 51 years and suffered a former non-sustained ventricular tachycardia before receiving a WCD. Among these patients suffering from appropriate WCD shock only two patients showed an LVEF<35%. Among the myocarditis patients 48% suffered from a former ventricular tachycardia and/or ventricular fibrillation and therefore received a WCD. Conclusions Myocarditis patients can be effectively protected by WCD and may benefit from its’ use. WCD shock occurred also in patients with an LVEF >35%.
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