title: Bridging a temporary high risk of sudden arrhythmic death. Experience with the wearable cardioverter defibrillator (WCD).
abstract: The implantable cardioverter defibrillator (ICD) is able to reduce sudden arrhythmic death in patients who are considered to be at high risk. However, the arrhythmic risk may be increased only temporarily as long as the proarrhythmic conditions persist, left ventricular ejection fraction remains low, or heart failure prevails. The wearable cardioverter defibrillator (WCD) represents an alternative approach to prevent sudden arrhythmic death until either ICD implantation is clearly indicated or the arrhythmic risk is considered significantly lower or even absent. The WCD is also indicated for interrupted protection by an already implanted ICD, temporary inability to implant an ICD, and lastly refusal of an indicated ICD by the patient. The WCD is not an alternative to the ICD, but a device that may contribute to better selection of patients for ICD therapy. The WCD has the characteristics of an ICD, but does not need to be implanted, and it has similarities with an external defibrillator, but does not require a bystander to apply lifesaving shocks when necessary. The WCD was introduced into clinical practice about 8 years ago, and indications for its use are currently expanding. This article describes the technological aspects of the WCD, discusses current indications for its use, and reviews the clinical studies with the WCD. Additionally, data are reported on the clinical experience with the WCD based on 354 patients from Germany hospitalized between 2000 and 2008 who wore the WCD for a mean of 3 months.
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-up Program, Rochester, New York 14642, USA. helmut.klein@heart.rochester.edu
authors.forename: Helmut U
authors.initials: HU
authors.lastname: Klein
authors.forename: Ulf
authors.initials: U
authors.lastname: Meltendorf
authors.forename: Sven
authors.initials: S
authors.lastname: Reek
authors.forename: Jan
authors.initials: J
authors.lastname: Smid
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kuss
authors.forename: Iwona
authors.initials: I
authors.lastname: Cygankiewicz
authors.forename: Christian
authors.initials: C
authors.lastname: Jons
authors.forename: Steven
authors.initials: S
authors.lastname: Szymkiewicz
authors.forename: Frank
authors.initials: F
authors.lastname: Buhtz
authors.forename: Anke
authors.initials: A
authors.lastname: Wollbrueck
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
mesh_terms: D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D017060:Patient Satisfaction; D018570:Risk Assessment; D017180:Tachycardia, Ventricular / Q000628:therapy*