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Wearable Cardioverter-Defibrillator — EECC MCQ

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ModerateGeneral CardiologyWearable Cardioverter-DefibrillatorEECC

A 55-year-old man collapses during a football match. Bystanders initiate CPR and apply an AED. The AED delivers one shock. Paramedics arrive and find VF on the monitor. After ROSC, he undergoes coronary angiography (normal), CMR (normal), and genetic testing (pending). His ECG and echo are normal. What is the role of the wearable cardioverter-defibrillator (WCD) while awaiting further evaluation?

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Correct answer: E — WCD may bridge the gap before a definitive ICD decision — it provides external defibrillation capability via a wearable vest without requiring surgical implantation; it is appropriate during diagnostic evaluation, post-MI waiting periods, or pending LVEF recovery assessment

The wearable cardioverter-defibrillator (WCD, e.g. LifeVest) is an external device worn as a vest that continuously monitors cardiac rhythm and delivers defibrillation if VT/VF is detected. The ESC 2022 VA/SCD Guidelines recommend WCD (Class IIb) as a bridge strategy in: (1) patients awaiting diagnostic evaluation (this scenario — cardiac arrest survivor with pending workup); (2) post-MI waiting period (ICD not implanted within 40 days post-MI — DINAMIT/IRIS interval); (3) pending LVEF recovery assessment (new DCM, post-myocarditis); (4) awaiting cardiac transplant; (5) ICD explanation for infection (temporary protection until reimplant). Advantages: no surgical implantation, removable, immediate protection. Limitations: patient must wear it continuously, electrode contact issues, cannot deliver ATP, false alarms (~1-2/day requiring patient response to abort). The VEST trial showed non-significant reduction in arrhythmic death (underpowered, low compliance).

Reference: ESC (2022): VA/SCD Guidelines; VEST Trial