Extended use of the wearable cardioverter-defibrillator in patients at risk for sudden cardiac death

Aims: Data on outcomes in patients using the wearable cardioverter-defibrillator (WCD) > 90 days are limited. We aimed to analyse the clinical course of patients with WCD use ≤90 days vs. WCD use >90 days. Methods and results: We assessed arrhythmia events during WCD use, and ejection fraction (EF) improvement/implantable cardioverter-defibrillator (ICD) implantation at the end of WCD use in patients with WCD use ≤90 days vs. WCD use >90 days enrolled in the WEARIT-II registry, further assessed by disease aetiology (ischaemic vs. non-ischaemic vs. congenital/inherited heart disease). There were 981 (49%) patients with WCD use >90 days, and 1019 patients with WCD use ≤90 days (median 120 vs. 55 days). There was a lower incidence of sustained ventricular tachycardia/ventricular fibrillation (VT/VF) events (11 vs. 50 events per 100 patient-years, P < 0.001), WCD treated VT/VF events (1 vs. 8 events per 100 patient-years, P < 0.001), and non-sustained VT events (21 vs. 51 events per 100 patient-years, P = 0.008) with WCD use >90 vs. WCD use ≤90 days. Non-ischaemic cardiomyopathy patients presented with similar rates of sustained VT/VF events during WCD use >90 vs. ≤90 days (13.4 vs. 13.7 events per 100 patient-years, P = 0.314), while most of these events terminated spontaneously. One-third of the patients with extended WCD use further improved their EF and they were not implanted with an ICD, with similar rates among ischaemic and non-ischaemic patients. Conclusions: In WEARIT-II, patients with extended WCD use >90 days remain at risk for ventricular arrhythmia events. One-third of the patients with WCD use >90 days further improved their EF, avoiding the need to consider ICD implantation.