A wearable automatic defibrillator may be an option for patients who are at risk for life-threatening heart rhythm abnormalities but are not good candidates for an implantable cardiac defibrillator (ICD), according to an advisory from the American Heart Association, published in its Circulation journal.
This is the American Heart Association’s first science advisory on wearable defibrillators.
“For many of these patients, the risk for life-threatening rhythm abnormalities may be temporary, so the wearable cardiac defibrillator could be a short-term alternative to an ICD, which is permanently implanted in a patient’s chest,” says Jonathan Paul Piccini, lead author of the advisory and a cardiac electrophysiologist at Duke University Medical Center in Durham, USA.
The advisory also notes that there is very little evidence to support systematic use of the wearable defibrillator and randomised clinical trials (like the VEST trial) are needed to determine if wearable defibrillators lead to improved outcomes.
“Although a growing number of patients are being prescribed wearable cardiac defibrillators by their doctors, there have been very few well-designed and completed studies of these devices. Wide spread use of the wearable defibrillator is not advisable because there is not enough clinical evidence to support its use, except in a small number of patients with known life-threatening arrhythmias but for whom surgery to implant an ICD is not advised in the short term,” says Piccini.
“Unfortunately, patients often find the wearable defibrillator uncomfortable,” Piccini says, adding that this is likely to change as the technology improves.
“As with most new medical technologies, biomedical engineers are working to make them smaller, more lightweight and less burdensome. One company is already developing a self-contained system in a large, self-adhesive plastic bandage that a wearer just sticks on their chest,” Piccini says.
In the meantime, larger, randomised and controlled clinical trials of the wearable defibrillator and similar technologies are critically needed before they are used widely in clinical practice, he says.