title: The Wearable Cardioverter Defibrillator: an Early Single Centre Australian Experience. Some Pitfalls and Caveats for Use.
abstract: BACKGROUND
  Wearable Cardioverter Defibrillators (WCD) have been effectively used for more than a decade in North America and Europe for prevention of sudden cardiac death (SCD) due to ventricular arrhythmias. This device has only recently been available in Australia.
  
  
  METHODS
  At Westmead hospital, WCD has been used since 2013 as a bridging therapy to an implantable cardioverter defibrillator (ICD) for those at high risk, but are temporarily not suitable for an implantable device. Indications for use were explanted infected ICD, dilated cardiomyopathy, post partum cardiomyopathy, valvular heart disease and myocarditis. The default device settings were: ventricular tachycardia (VT) and ventricular fibrillation (VF) threshold of 150 bpm and 200 bpm respectively and response times were 60 secs for VT and 25 secs for VF.
  
  
  RESULTS
  WCD was used in eight patients. Duration of use ranged from five to 180 days with median of 77 days. Daily usage averaged 23.4±0.6hours. All except one were compliant with the device and none of our patients received shock or died during device usage. Four of the eight patients received ICD, two declined ICD, one was judged to no longer require ICD and one remains under assessment.
  
  
  CONCLUSIONS
  WCD is easy to use, well tolerated and is effective for SCD prevention in patients who are temporarily not suitable for ICD. However patients need to be actively followed-up to reduce the duration of WCD usage and thereby be cost effective.
authors.affiliation: Cardiology Department, Westmead Hospital, Sydney, NSW, Australia. Electronic address: apad7867@uni.sydney.edu.au.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Bhaskaran
authors.affiliation: Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: Monique
authors.initials: M
authors.lastname: Bartlett
authors.affiliation: Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: Pramesh
authors.initials: P
authors.lastname: Kovoor
authors.affiliation: Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Davis
mesh_terms: D001315:Australia; D047548:Defibrillators; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D013997:Time Factors
keywords: Life Jacket; Ventricular arrhythmia; Wearable Cardioverter Defibrillator