The wearable cardioverter-defibrillator vest: Indications and ongoing questions

Abstract

Multiple clinical trials have demonstrated the efficacy of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death (SCD) among specific high-risk populations. However, it remains unclear how to optimally treat those patients who are at elevated risk of cardiac arrest but are not among the presently identified groups proven to benefit from an ICD, are unable to tolerate surgical device implantation, or refuse invasive therapies. The wearable cardioverter-defibrillator (WCD) is an alternative antiarrhythmic device that provides continuous cardiac monitoring and defibrillation capabilities through a noninvasive, electrode-based system. The WCD has been shown to be highly effective at restoration of sinus rhythm in patients with a ventricular tachyarrhythmia, and one randomized trial using the WCD in patients with recent myocardial infarction at elevated risk for arrhythmic death reported a decrease in overall mortality despite no SCD mortality benefit. The current clinical indications for WCD use are varied and continue to evolve as experience with this technology increases.

Wearable cardioverter-defibrillator (life-vest): A feasible bridging treatment in adult congenital heart disease

“…WCD is ideally indicated as temporary therapy (three to six months) for patients at a high risk for SCD [ [7] , [8] , [9] , [10] ]. Current ICD implantation guidelines stress the importance of avoiding ICD therapy in patients with reversible arrhythmic disorders or risk factors [ 7 , 11 ]. Given these issues, WCD therapy is best suited for clinical scenarios in which the risk of SCD is temporary, or when the wearable device can be used to bridge the patient to a more definitive treatment (ICD implant or surgery).…”

An optimized long QT syndrome differentiating protocol: A new indication for wearable cardioverter-defibrillator vests

“…It was presumed that QT shortening after the amiodarone washout period, along with VEs ablation would allow the patient to avoid an ICD implant. WCD is best suited for clinical scenarios in which the risk of VT/VF is temporary or to bridge the patient to a more definitive treatment [4,5]. To the best of our knowledge this is the first described use of WCD for a patient with suspected drug-induced LQTS, and, therefore, a temporarily elevated risk of VT/VF.…”

The wearable cardioverter-defibrillator is not needed for most high-risk patients

“…The WCD system is composed of 4 components: (1) a garment facilitating positioning of an electrode belt, (2) the electrode belt that incorporates 4 sensing (2 electrocardiograph channels) and 3 defibrillation nonadhesive electrodes, (3) charger, and (4) the monitor pack ( Figure 1). 3,4 The latter houses the rechargeable battery, the patient response button, and a touch screen that allows the patient to capture and transmit information about their rhythm, engage in a 6minute hall walk test, and enter information to ascertain quality-of-life (QoL) indices. Arrhythmia detection is technically challenging, as the 4 dry sensing electrodes are prone to skin motion artifact or loss of contact; this necessitates sophisticated compensatory algorithms to minimize false alarms and inappropriate therapy.…”