When is therapy with the wearable cardioverter defibrillator (WCD) indicated?-T.T., MD.

Kerry J. Estes, BSN, RN, replies: A WCD, an external device that resembles a vest, can save the lives of patients who are at risk for sudden cardiac death (SCD) by delivering synchronized electrical cardioversion or defibrillation for ventricular tachycardia and ventricular fibrillation. Although similar to implantable cardioverter defibrillators (ICDs), temporary therapy with the WCD is indicated for patients at risk for SCD.1

Patients who can benefit from temporary use of the WCD include patients with:

* recent myocardial infarction or coronary revascularization with severe left-ventricular dysfunction

* severe cardiomyopathy as a bridge to cardiac transplant

* syncope and a high risk of ventricular tachydysrhythmias

* newly diagnosed nonischemic cardiomyopathy with severely diminished left-ventricular ejection fraction

* clinical conditions that delay or prohibit ICD implantation, such as infection

* ICD explantation.2,3

The WCD records and stores data regarding cardiac rhythms before, during, and after therapeutic shocks, giving the healthcare provider valuable patient information.1 The WCD is associated with improved quality of life because patients can return to most of their normal activities while having the security of the WCD.1

There are limitations to using the WCD in certain patients. The patient must be willing to wear the vest, which must fit correctly and be applied properly by the patient. The vest can be somewhat awkward to wear and can interfere with some activities. It must be worn at all times and removed only for bathing or showering; someone trained in CPR, such as a family member or caregiver, will need to be close by during this temporary interruption in use.1

The lifesaving benefits of the WCD appear to far outweigh any of its limitations. Make sure that patients and caregivers receive the education needed to use this device correctly.

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