Monitoring Parameters for Patients with a Life Vest (Wearable Cardioverter-Defibrillator)

Device Functionality Monitoring

The American College of Cardiology recommends ensuring the monitor/defibrillator unit is properly charged and operational 3
The British Medical Journal suggests verifying that electrode pads maintain proper contact with the skin to ensure effective shock delivery if needed 4

The American College of Cardiology and Circulation recommend tracking daily wear time, as greater benefit has been demonstrated in patients who are compliant with wearing the device 1, 2
The American College of Cardiology notes that in the VEST trial, only 12 of 48 patients were wearing the device at the time of death, highlighting the importance of compliance monitoring 1
Circulation suggests documenting any periods of non-compliance and addressing barriers to proper usage 2

The British Medical Journal and Circulation recommend monitoring for ventricular arrhythmias, particularly ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), which are the primary arrhythmias the life vest is designed to treat 5, 6
The American College of Cardiology suggests paying special attention to patients with left ventricular ejection fraction (LVEF) ≤35%, as they are at higher risk for life-threatening arrhythmias 1, 3
Circulation recommends tracking any recorded events or shocks delivered by the device 2
Circulation suggests documenting any symptoms that occurred during recorded arrhythmia episodes 6, 7

The American College of Cardiology recommends monitoring for signs of worsening heart failure, particularly in patients with reduced LVEF 1
The American College of Cardiology suggests assessing for symptoms of cardiac ischemia, as the risk of ventricular arrhythmias and sudden cardiac death is highest early after myocardial infarction 1
The British Medical Journal recommends monitoring electrolyte levels, particularly potassium and magnesium, as imbalances can trigger arrhythmias 8, 9
The American College of Cardiology suggests tracking medication compliance, especially beta-blockers and antiarrhythmic therapy in patients with ventricular arrhythmias 1

The American College of Cardiology recommends more intensive monitoring for patients who have recently experienced myocardial infarction with LVEF ≤35%, as they are at highest risk in the first month 1, 3
The American College of Cardiology notes that the life vest is often used as a bridge to ICD implantation, so regular reassessment of ICD candidacy is important 1
The American College of Cardiology suggests that if the patient has a history of high-degree atrioventricular block, additional monitoring for bradyarrhythmias may be necessary 1

Circulation recommends performing a thorough assessment including vital signs, ECG, and symptom evaluation after a shock is delivered 6, 7
Circulation suggests documenting the rhythm before and after shock delivery 6
The British Medical Journal recommends checking for proper pad placement and skin contact after a shock 4

Circulation warns against relying solely on the life vest for monitoring, as it is designed primarily for treatment rather than continuous monitoring 2
Circulation suggests ensuring patients understand that the life vest is not a substitute for seeking medical attention when experiencing cardiac symptoms 2
The British Medical Journal recommends removing transdermal medication patches from areas where defibrillator pads will be placed to prevent electrical arcing 8, 4