Wearable Cardioverter Defibrillator in Patient With Transient Risk of Sudden Cardiac Death: Single Centre Experience

Background Nowadays sudden cardiac death (SCD) remains a major cause of death, despite the recent progress in prevention and interventions of cardiac disease. In case of transient risk of SCD, the use of a wearable cardioverter defibrillator (WCD) is recommended in current guidelines. The purpose of this study was to investigate the safety and the adherence to WCD in a real world population; moreover, we reviewed the rate of ICD implantation after WCD use. Methods We considered consecutively 130 patients discharged from our cardiology department for potentially transient high risk of SCD, weared a WCD from August 2017 to December 2025. The patients were discharged with WCD protection and followed through remote monitoring or outpatient. A clinical and echocardiographic evalutation was performed at baseline and at the end of the WCD use period. Results Out of 130 patients, with average age 64,9±11,9 years old and baseline average left ventricular ejection fraction (LVEF) 31 ±9,5,79 % were males,72% suffered from arterial hypertension, 25% diabetes mellitus 16% chronic renal failure ,6% previous stroke, 22% atrial fibrillation (AF). 57% of these patients weared WCD for severe systolic dysfunction in ischemic cardiac disease, 3% after removal of an infected ICD, 40% after newly diagnosed cardiomyopathy. 84% patients were in therapy with beta blockers, 39% with sacibitril/valsartan and 38% with glifozine. The average wearing time of WCD was 61±42,9 days and 23±2,4 hours daily. We received these events: 2 sustained ventricular tachicardia, 6 non sustained ventricular tachicardia (TV) 4 atrial fibrillation. One patient received inappropriate shock. At the end of the WCD use,42% of patients proceeded to device implantation. At last follow up 14 deaths was detected in patients that weared WCD due to advanced heart failure. Considering sex difference, we observed in females a better baseline LVEF (f 34±9vs m 29±8,1 p=0,03) and a significant lower ICD implantation rate at the end of WCD use [f 7(26%) vs m 48(55%)p=0.04]. During wearing time 7 Tv occurred in males and 1 in females. Conclusions In our experience we may confirm that WCD use is, effective, safe and with a good adherence in all patients. The WCD allows resources saving not only during therapy titration but also by enabling arli discharge supporting appropriate decision making regarding ICD implantation. Females presented a lower ICD implantation rate