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Cost utility of wearable cardioverter-defibrillators in children with dilated cardiomyopathy during medical optimization: Is it worth the wait?

  • Jeffrey J. Kim
    Correspondence
    Address reprint requests and correspondence: Dr Jeffrey J. Kim, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, 6651 Main St, Suite E1920, Houston, TX 77030.
    Affiliations
    Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
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Published:September 14, 2019DOI:https://doi.org/10.1016/j.hrthm.2019.09.015
      Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy in both adults and children, and the estimated cost of caring for patients with this disease is in the order of billions of dollars annually in the United States alone. Although in adults the etiology is usually related to coronary artery disease, in children the mechanisms are far more varied and the course is less well described and likely dependent on cause and presentation.
      • Towbin J.A.
      • Lowe A.M.
      • Colan S.D.
      • et al.
      Incidence, causes and outcomes of dilated cardiomyopathy in children.
      An important facet of the management paradigm for these children includes approach to sudden death prevention, an area that continues to lack substantial data. Although the estimated rate of sudden cardiac arrest (SCA) in this population is likely relatively low,
      • El-Assaad I.
      • Al-Kindi S.G.
      • Oliveira G.H.
      • et al.
      Implantable cardioverter-defibrillator and wait-list outcomes in pediatric patients awaiting heart transplantation.
      ,
      • Dimas V.V.
      • Denfield S.W.
      • Friedman R.A.
      • et al.
      Frequency of cardiac death in children with idiopathic dilated cardiomyopathy.
      vigilance related to primary and secondary prevention is perhaps the practitioner’s greatest worry.
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      Linked Article

      • Wearable cardioverter-defibrillators in pediatric cardiomyopathy: A cost-utility analysis
        Heart RhythmVol. 17Issue 2
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          Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children. Patients with severe cardiac dysfunction are thought to be at risk of sudden cardiac arrest (SCA). After diagnosis, a period of medical optimization is recommended before permanent implantable cardioverter-defibrillator (ICD) implantation. Wearable cardioverter-defibrillators (WCDs) provide an option for arrhythmia protection as an outpatient during this optimization.
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