Abstract
A wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and for patients who are temporarily not candidates for an implantable cardioverter defibrillator (ICD). In addition, the need for telemedical concepts in the detection and treatment of heart failure (HF) and its arrhythmias is growing. The WCD has evolved from a shock device detecting malignant ventricular arrhythmias (VA) and treating them with shocks to a heart-failure-monitoring device that captures physical activity and cardioacoustic biomarkers as surrogate parameters for HF to help the treating physician surveil and guide the HF therapy of each individual patient. In addition to its important role in preventing SCD, the WCD could become an important tool in heart failure treatment by helping prevent HF events by detecting imminent decompensation via remote monitoring and monitoring therapy success.
Highlights
Besides patients with inherited cardiomyopathies or channelopathies who often present with arrhythmias without clinical evidence of systolic dysfunction, a high percentage of patients prescribed with a wearable cardioverter defibrillator (WCD) suffer from heart failure with reduced ejection fraction (HFrEF)
Following the current ESC heart failure guidelines [50], the decision about implanting an implantable cardioverter defibrillator (ICD) should be made after implementation of an optimal medical therapy (OMT) for three months while patients are at risk for sudden cardiac death (SCD) and seem to be unprotected
ICD implantations during up establishment and up-titration of heart failure therapy was tested in the PROLONG study [60], with 156 patients (54 ± 14 years, 35% female) with a left ventricular ejection fraction (LVEF) 24 ± 7% being prescribed with a WCD after being newly diagnosed with HFrEF
Summary
According to data from the World Health Organization, more than 17 million people per year die due to cardiovascular diseases (CVD), making this entity responsible for every third death worldwide Within these CVD-related deaths, around 25% is categorized as sudden cardiac death (SCD) [1,2]. The implantation of an ICD should be reserved for patients with a permanent high risk for SCD rather than those with a potentially reversible SCD risk The latter group of patients with a temporary risk for SCD may be candidates for a wearable cardioverter defibrillator (WCD). The wearable cardioverter defibrillator (WCD) was developed to find a potential solution to protecting patients with a temporary high SCD risk or with a permanent risk for SCD who are not eligible for immediate ICD implantation [8,9,10]
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