The wearable defibrillator: current technology, indications and future directions.

PURPOSE OF REVIEW: The wearable cardioverter-defibrillator has been available for over a decade. In recent years, the device has been prescribed increasingly for a wide range of indications. The purpose of this review is to describe the technical and clinical aspects of the wearable cardioverter-defibrillator. The available literature on safety, efficacy and cost-effectiveness is reviewed, and indications for use will be discussed.

RECENT FINDINGS: The wearable cardioverter-defibrillator has been used successfully in more than 100 000 patients for a variety of indications. These include high-risk patients after myocardial infarction or revascularization or with heart failure and newly diagnosed cardiomyopathy. It has also been used to bridge the time period of postponed implantable cardioverter-defibrillator implantation or reimplantation, or until heart transplantation. It has been shown that the device safely and effectively terminates ventricular tachycardia and fibrillation with high first shock success. Patient compliance has been high. Although no randomized trial has been published yet, several guidelines recommend wearable cardioverter-defibrillator use in different patient populations and clinical scenarios.

SUMMARY: The wearable cardioverter-defibrillator effectively bridges a limited time period in patients with a real or perceived high risk for sudden cardiac arrest and may become a helpful tool for risk stratification to better select patients for primary prevention implantable cardioverter-defibrillator placement.