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  • Title: The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients.
    Author: Erath JW, Vamos M, Sirat AS, Hohnloser SH.
    Journal: Clin Res Cardiol; 2017 Apr; 106(4):300-306. PubMed ID: 27888304.
    Abstract:
    BACKGROUND: The wearable cardioverter-defibrillator (WCD) is used for temporary protection of patients deemed to be at high risk for sudden death (SCD) not yet meeting indications for the implantable defibrillator (ICD). OBJECTIVES: To evaluate the efficacy, safety, and compliance of/to WCD use and subsequent medium-term outcome of patients in a single-center observational study. METHODS: A total of 102 consecutive patients were fitted with the WCD from 2012 to 2015 and followed for a mean of 11 months (±8 months). RESULTS: The most common clinical indication for WCD-prescription (63%) was a new diagnosis of severely impaired LV function (LVEF ≤35%). The median wear time of the WCD was 54 days with a daily use of 23 h. Appropriate WCD therapy occurred in four patients (seven shocks for VF, one shock for VT). An ICD was finally implanted in 56 patients (55%). Improvement in LV function was the most common reason not to implant an ICD (HR 0.37; 95% CI 0.19-0.73; p = 0.004). Two patients had inappropriate shocks from their WCD due to atrial fibrillation/flutter. Five patients fitted with an ICD after the end of WCD therapy suffered VT/VF episodes. After wearing the WCD, six patients died (five ICD recipients and one non-ICD recipient). CONCLUSION: WCD therapy was well accepted by patients and provided temporary protection against ventricular tachyarrhythmias in patients at risk for SCD. The WCD may help to avoid unnecessary ICD implantations in a significant proportion of patients.
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