Wearable cardioverter-defibrillator in clinical practice — what we know and what questions are still to be answered

Sudden cardiac death remains a major contributor to cardiovascular mortality worldwide. The wearable cardioverter-defibrillator (WCD) provides temporary, non-invasive protection from sudden arrhythmic death through continuous rhythm monitoring and automatic detection and treatment of ventricular tachycardia and ventricular fibrillation. Accumulating evidence demonstrates high defibrillation efficacy, low rates of inappropriate shocks, and a clinically meaningful role in patients with transiently elevated or uncertain arrhythmic risk. The WCD is increasingly used as a bridge to recovery, implantable cardioverter-defibrillator implantation, or further risk stratification in conditions such as newly diagnosed heart failure with reduced ejection fraction, recent myocardial infarction, myocarditis, and after implantable cardioverter-defibrillator explantation. At the same time, the clinical effectiveness of WCD therapy is highlydependent on patient adherence, structured follow-up, and appropriate patient selection. Recent studies have further highlighted the role of the WCD not only as a temporary safeguard against sudden cardiac death, but also as a tool for protected risk stratification during periods of dynamic and evolving arrhythmic risk. This review summarizes current evidence supporting WCD therapy, discusses its role within contemporary heart failure and arrhythmia management pathways, highlights remaining knowledge gaps, and examines differences in implementation and reimbursement across selected European countries.