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Wearable Cardioverter-Defibrillator — EECC MCQ

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HardHeart FailureWearable Cardioverter-DefibrillatorEECC

A 62-year-old man with HFrEF (LVEF 22%) develops symptomatic sustained VT at 3 months after diagnosis. He is on optimal GDMT but has not yet met the standard timeframe for primary prevention ICD consideration. What is the most appropriate short-term protection strategy while awaiting reassessment?

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Correct answer: D — Use a wearable defibrillator as a short-term bridge

The wearable cardioverter-defibrillator (WCD, LifeVest) provides temporary SCD protection for patients at high risk but not yet meeting criteria for permanent ICD. Indications include: newly diagnosed HFrEF awaiting LVEF reassessment after 3 months of GDMT (to determine if LVEF recovers above 35%), early post-MI (<40 days), and post-ICD explant for infection. The VEST trial showed non-significant mortality reduction but WCD remains a Class IIb recommendation in ESC guidelines for temporary protection. In this patient with sustained VT (a secondary prevention indication), the episode itself may warrant direct ICD implantation rather than WCD, but if the clinical decision is to optimise GDMT first, WCD provides interim protection.

Reference: ESC (2022): Guidelines on VA and SCD Prevention: https://bnf.nice.org.uk/