Who Should Receive a Wearable Defibrillator Vest at Hospital Discharge?
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Purpose of Review
To discuss the role of wearable cardioverter defibrillator (WCD) vests in preventing sudden cardiac death (SCD) in at-risk populations.
The impact of randomized-controlled trials with implantable cardioverter-defibrillators (ICD) therapy is well established in randomized clinical trials in ischemic cardiomyopathy. Although the benefits are not as clear in non-ischemic cardiomyopathy, meta-analyses show significant mortality benefits from immediate electrical cardioversion strategies. The role of WCDs in at-risk populations in whom ICD therapy is temporarily not indicated is not as well-established. Smaller cohort trials have shown efficacy in patients with newly-diagnosed cardiomyopathy, requiring temporary ICD explantation, and others with less common indications for WCD therapy.
The Vest Prevention of Early Sudden Death Trial was a landmark randomized control study seeking to examine the benefits of WCD therapy in at-risk population, and although the primary endpoint of reducing arrhythmic death was not reached, the structure of the trial and significant differences in total mortality make a compelling case for continued use of WCD therapies in our healthcare systems.
KeywordsWearable cardioverter-defibrillator Sudden cardiac death Ventricular arrhythmias Ischemic heart disease Implantable cardioverter-defibrillator
Compliance with Ethical Standards
Conflict of Interest
Sergey Kachur has no disclosures.
Daniel P. Morin reports research grants from Medtronic and Boston Scientific, is a consultant for Abbott, and has received speaker honoraria from Medtronic and ZOLL. Also, Dr. Morin served on the steering committee for the VEST trial, and was one of the authors of the main VEST study manuscript (October 2018, N Engl J Med).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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