title: Outpatient treatment with the wearable cardioverter defibrillator: clinical experience in two Dutch centres.
abstract: BACKGROUND
  The latest European Society of Cardiology Guidelines recommend consideration of a wearable cardioverter-defibrillator (WCD) for patients with a poor left ventricular ejection fraction (LVEF) who are at risk of sudden arrhythmic death but are not eligible for an implantable defibrillator. For these patients a WCD can be an alternative to long-term hospitalisation.
  
  
  OBJECTIVE
  To evaluate the use of WCD therapy in these patient groups in two Dutch centres.
  
  
  METHODS
  All consecutive patients treated with the WCD between 2009 and 2016 were included from two centres in the Netherlands. Data on events and compliance were collected retrospectively through home monitoring systems and adjudicated by the investigators.
  
  
  RESULTS
  A total of 79 patients were treated with a WCD. Common indications were newly diagnosed cardiomyopathy without optimal medical treatment in 46 patients (58.2%) and bridge to implantable cardioverter-defibrillator (ICD) implant in 33 patients (41.8%). Bridge to implant indications consisted of contraindications for immediate implantation such as infections (e. g. previous device-related infections) and radiotherapy. Compliance was over 97% per day (median 23.3 h, 22.6-23.7), during a median of 79 days (50.0-109.8.0). Two patients (2.6%) received an appropriate shock (annual rate 13.6%), there was 1 (1.3%) inappropriate shock (annual rate 6.7%). In 24 patients (52.2%) without optimal medical treatment, the LVEF was sufficiently improved and ICD implant was avoided. Eight (10.1%) patients did not receive an ICD. In 45 patients an ICD was implanted (57.0%).
  
  
  CONCLUSIONS
  WCD therapy provides a safe and effective treatment in outpatient setting for patients at high risk for sudden cardiac death and reduces the number of ICDs implanted.
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands. a.f.quast@amc.uva.nl.
authors.forename: A F B E
authors.initials: AFBE
authors.lastname: Quast
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: V F
authors.initials: VF
authors.lastname: van Dijk
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A A M
authors.initials: AAM
authors.lastname: Wilde
authors.affiliation: Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: R E
authors.initials: RE
authors.lastname: Knops
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: L V A
authors.initials: LVA
authors.lastname: Boersma
keywords: Sudden death; Ventricular arrhythmias; Wearable cardioverter defibrillator