title: The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients.
abstract: BACKGROUND
  The wearable cardioverter-defibrillator (WCD) is used for temporary protection of patients deemed to be at high risk for sudden death (SCD) not yet meeting indications for the implantable defibrillator (ICD).
  
  
  OBJECTIVE
  To evaluate the efficacy, safety, and compliance of/to WCD use and subsequent medium-term outcome of patients in a single-center observational study.
  
  
  METHODS
  A total of 102 consecutive patients were fitted with the WCD from 2012 to 2015 and followed for a mean of 11 months (±8 months).
  
  
  RESULTS
  The most common clinical indication for WCD-prescription (63%) was a new diagnosis of severely impaired LV function (LVEF ≤35%). The median wear time of the WCD was 54 days with a daily use of 23 h. Appropriate WCD therapy occurred in four patients (seven shocks for VF, one shock for VT). An ICD was finally implanted in 56 patients (55%). Improvement in LV function was the most common reason not to implant an ICD (HR 0.37; 95% CI 0.19-0.73; p = 0.004). Two patients had inappropriate shocks from their WCD due to atrial fibrillation/flutter. Five patients fitted with an ICD after the end of WCD therapy suffered VT/VF episodes. After wearing the WCD, six patients died (five ICD recipients and one non-ICD recipient).
  
  
  CONCLUSIONS
  WCD therapy was well accepted by patients and provided temporary protection against ventricular tachyarrhythmias in patients at risk for SCD. The WCD may help to avoid unnecessary ICD implantations in a significant proportion of patients.
authors.affiliation: Goethe University Hospital, Frankfurt, Hessen, Germany. julia.erath@gmx.net.
authors.forename: Julia W
authors.initials: JW
authors.lastname: Erath
authors.affiliation: Goethe University Hospital, Frankfurt, Hessen, Germany.
authors.forename: Mate
authors.initials: M
authors.lastname: Vamos
authors.affiliation: Goethe University Hospital, Frankfurt, Hessen, Germany.|Helios Klinikum Siegburg, Siegburg, Germany.
authors.forename: Abdul Sami
authors.initials: AS
authors.lastname: Sirat
authors.affiliation: Goethe University Hospital, Frankfurt, Hessen, Germany.
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D047548:Defibrillators / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012042:Registries; D017180:Tachycardia, Ventricular / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Congestive heart failure; Implantable cardioverter defibrillator; Sudden cardiac death; Ventricular arrhythmia; Wearable cardioverter defibrillator