Key result
WCD fails to reduce arrhythmic death vs control early after MI with reduced EF.
Why the study?
Following the recent publication of the first randomized trial evaluating the wearable cardioverter-defibrillator after myocardial infarction, this review was conducted to provide insight into data from the VEST trial and put findings into perspective with other studies and clinical experience.
Does the wearable cardioverter-defibrillator prevent sudden cardiac death in patients with severe left ventricular dysfunction during the waiting period for an implantable cardioverter-defibrillator?
Does the wearable cardioverter-defibrillator prevent sudden cardiac death in patients with severe left ventricular dysfunction during the waiting period for an implantable cardioverter-defibrillator?
Absolute Event Rate: 1.6% vs 2.4%
p-value: p=0.18
The wearable cardioverter-defibrillator offers a non-invasive, temporary strategy to protect against sudden cardiac death during the high-risk waiting period before ICD implantation, though its real-world effectiveness is highly dependent on patient compliance.
Does not support routine WCD use early post-MI; leaves open whether compliance-optimized strategies benefit selected patients.
Sudden cardiac death (SCD) is the most frequent cause of cardiovascular death in industrialized nations. Patients with cardiomyopathy are at increased risk for SCD and may benefit from an implantable cardioverter-defibrillator (ICD). The risk of SCD is highest in the first months after myocardial infarction or first diagnosis of severe non-ischemic cardiomyopathy. On the other hand, left ventricular function may improve in a subset of patients to such an extent that an ICD might no longer be needed. To offer protection from a transient risk of SCD, the wearable cardioverter-defibrillator (WCD) is available. Results of the first randomized clinical trial investigating the role of the WCD after myocardial infarction were recently published. This review is intended to provide insight into data from the VEST trial, and to put these into perspective with studies and clinical experience. As a non-invasive, temporary therapy, the WCD may offer advantages over early ICD implantation. However, recent data demonstrate that patient compliance and education play a crucial role in this new concept of preventing SCD.
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Israel et al. (2022) conducted a review in Myocardial infarction with reduced LVEF (n=2,302). Wearable cardioverter-defibrillator (WCD) vs. Guideline-directed heart failure medication alone was evaluated on Arrhythmic death (death by sudden cardiac death or VT) (p=0.18). The wearable cardioverter-defibrillator did not significantly reduce arrhythmic death compared to control in patients early after myocardial infarction with reduced ejection fraction.
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