Abstract
Considering the Need to Expand the Indications for Wearable Defibrillator Therapy.
Highlights
The case presented by Johnston et al.[1] is remarkable for its successful negotiation of several clinical challenges
The prescription of a wearable cardioverter- defibrillator (WCD) in this patient with syncope is not routine; the case is well-described, it is difficult at first glance to understand what clinical features led the clinicians to prescribe the WCD
The Vest Prevention of Early Sudden Death Trial and VEST Registry (VEST) study was negative for the reduction of sudden cardiac death (SCD) in the postmyocardial-infarction “waiting” period, but was likely underpowered and had a protracted enrollment period, during which time, the enrollment target was reduced
Summary
The case presented by Johnston et al.[1] is remarkable for its successful negotiation of several clinical challenges. Recognized historical high-risk features were largely absent in the history—these typically include the absence of a prodrome, injury associated with the syncope, family history of sudden death, and prior cardiac disease. It appears that the only high-risk feature in this patient was the exertional nature of one of her two episodes of syncope. Given the myriad clues and nonverbal cues that we process when interviewing a patient and their family, it may be difficult to identify exactly what features convinced the treating physicians to prescribe the WCD. The author reports no conflicts of interest for the published content
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