Wearable cardioverter defibrillators: dead on arrival or chance of survival?

Sudden cardiac death affects over 300,000 individuals annually in the United States (1-4), and it comprises 40–50% of total cardiovascular disease-related deaths (3). The wearable cardioverter defibrillator (WCD) gained FDA approval in 2002 (5) and is a guideline-directed therapy intended to reduce the risk of sudden cardiac death from death from ventricular tachyarrhythmias, including ventricular fibrillation (VF) or ventricular tachycardia (VT) (2,6). However, it is well-documented that ideal use of the WCD (trade name LifeVest^®) is constrained by size and weight of the device as well as development of a rash (7-9). The recent groundbreaking research released by the VEST Trial investigators has cast further doubt on the validity of the device by failing to demonstrate a significantly lower rate of death from tachyarrhythmias among WCD users (10). Also considering that premature discontinuation rates are as high as 30% (11), this begs the question: Is the WCD dead on arrival, or does it have a chance of survival with some modifications?