2019 Volume 26 Issue 5 Pages 385-390
Implantable cardioverter defibrillators (ICDs) are commonly-used devices for secondary prevention of sudden death in patients who have recovered from cardiac arrest. However, challenges arise when patients are travelers from countries where ICDs are not available. A wearable cardioverter defibrillator (WCD) can be a useful alternative in this situation. A 72-year-old Tajikistani woman with a history of ischemic cardiomyopathy had ventricular fibrillation during her stay in Japan. She was successfully resuscitated after immediate cardiopulmonary resuscitation and transferred to our hospital. Emergent coronary angiography revealed chronic total occlusion (CTO) of the left anterior descending artery (LAD) and subtotal occlusion of the right coronary artery (RCA). Primary percutaneous coronary intervention (PCI) to the RCA was successfully performed and the patient fully recovered after targeted temperature management at 34°C for 24 hours. However, ventricular arrhythmia recurred after rewarming and PCI was also performed on the CTO of LAD. Secondary prevention for ventricular fibrillation was indicated, however the patient had to return to Tajikistan, where the appropriate ICD management is not available. In addition, the patient could not pay for the cost as she had no health insurance in Japan. A WCD was indicated as an alternative to ICD implantation. After receiving permission to wear a WCD during air travel, the patient was able to safely return to Tajikistan. WCD might be a useful option for foreign travelers who require secondary prevention for lethal ventricular arrhythmias, to enable them to return to their home country.
