Wearing Protection or Wearing Assumptions? A Critical Reappraisal of the Wearable Cardioverter-Defibrillator
- 1Azienda Unità Sanitaria Locale Toscana Sud Est, Misericordia Hospital, Via Senese 161, 58100 Grosseto, Italy
Abstract
The wearable cardioverter-defibrillator (WCD) has become an accepted temporary strategy for patients considered at transient risk of sudden cardiac death and its use has rapidly expanded across a broad range of clinical settings. However, more than twenty years after its introduction, the evidence supporting its routine use remains surprisingly limited. This review revisits the background rationale, randomized evidence and observational literature. Rather than questioning the technical ability of the WCD to terminate ventricular arrhythmias, we critically examine whether available evidence demonstrates a meaningful improvement in prognosis. We discuss the lessons learned from early post-myocardial infarction Implantable Cardioverter Defibrillator (ICD) trials, the limitations of using appropriate shocks as surrogate endpoints, the interpretation of the VEST trial, the strengths and weaknesses of registry-based evidence, patient adherence and quality-of-life issues, the economic implications of WCD therapy, and the need for a more selective, evidence-based use of the WCD that identifies patients most likely to derive meaningful clinical benefit while promoting responsible stewardship of healthcare resources.
Related
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- Transient defibrillation threshold elevation associated with air in the generator pocket after extravascular implantable cardioverter-defibrillator implantation.
- Intraoperative preservation of an extravascular implantable cardioverter-defibrillator lead during coronary artery bypass grafting.
- Electrode perforation of a silicone breast implant in a subcutaneous implantable cardioverter-defibrillator carrier: A previously unreported device complication.
BibTeX
@article{sensi2026wearing,
title = {{Wearing Protection or Wearing Assumptions? A Critical Reappraisal of the Wearable Cardioverter-Defibrillator}},
author = {Francesco De Sensi and Pasquale Baratta and Ugo Limbruno},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218358},
url = {https://www.mdpi.com/2077-0383/15/21/8358},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Wearing Protection or Wearing Assumptions? A Critical Reappraisal of the Wearable Cardioverter-Defibrillator
AU - Francesco De Sensi
AU - Pasquale Baratta
AU - Ugo Limbruno
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218358
UR - https://www.mdpi.com/2077-0383/15/21/8358
AB - The wearable cardioverter-defibrillator (WCD) has become an accepted temporary strategy for patients considered at transient risk of sudden cardiac death and its use has rapidly expanded across a broad range of clinical settings. However, more than twenty years after its introduction, the evidence supporting its routine use remains surprisingly limited. This review revisits the background rationale, randomized evidence and observational literature. Rather than questioning the technical ability of the WCD to terminate ventricular arrhythmias, we critically examine whether available evidence demonstrates a meaningful improvement in prognosis. We discuss the lessons learned from early post-myocardial infarction Implantable Cardioverter Defibrillator (ICD) trials, the limitations of using appropriate shocks as surrogate endpoints, the interpretation of the VEST trial, the strengths and weaknesses of registry-based evidence, patient adherence and quality-of-life issues, the economic implications of WCD therapy, and the need for a more selective, evidence-based use of the WCD that identifies patients most likely to derive meaningful clinical benefit while promoting responsible stewardship of healthcare resources.
SN - 2077-0383
ER -