Wearable Cardioverter-Defibrillator Applications in Cardiac Arrhythmias

The wearable cardioverter-defibrillator (WCD) is a non-invasive external device designed to detect and terminate life-threatening ventricular tachyarrhythmias in patients at elevated risk of sudden cardiac death. Worn as a vest beneath clothing, the WCD continuously monitors the heart rhythm and delivers a therapeutic shock when sustained ventricular tachycardia or fibrillation is detected. Its primary role is to bridge periods of uncertain risk, such as the early phase after myocardial injury or during optimisation of heart failure therapy, and to provide temporary protection when immediate implantation of a permanent device is not indicated or must be deferred. In addition to arrhythmia termination, WCD use offers real-time insights into patient compliance and physical activity, informing personalised risk stratification. Clinical experience has demonstrated that WCD deployment can reduce untimely implantable cardioverter-defibrillator (ICD) implantation by allowing left ventricular function to recover under guideline-directed medical therapy, while also serving as an effective safeguard during high-risk intervals such as device explantation or acute myocardial infarction recovery. The global adoption of WCDs underscores their value in diverse healthcare settings, improving shared decision-making and patient outcomes in the management of ventricular arrhythmias.

Research from Nature Portfolio

Data emerging from a multicentre registry of patients who received a WCD following explantation of an existing ICD system highlight its efficacy as a bridge until re-implantation. Over an average of two months of wear, approximately 7% of patients experienced appropriate shocks, illustrating that malignant ventricular tachyarrhythmias remain common in this cohort. The registry further revealed rehospitalisation rates for arrhythmias and heart failure, underscoring the need for continuous monitoring in the post-explant period.

Real-world experience across centres in Germany and Switzerland has characterised patient demographics, compliance and outcomes in routine practice. In a study of over 700 individuals, mean daily wear time exceeded 21 hours and left ventricular ejection fraction (LVEF) improved above 35% in nearly half of cases during follow-up. Appropriate shock delivery was documented in just over 2% of patients, with high rates of subsequent ICD implantation in those with persistent dysfunction. Notably, younger age was associated with reduced adherence, while regional differences in wear duration and device re-implantation reflect local practice patterns.

Wearable Cardioverter-Defibrillator Applications in Cardiac Arrhythmias publication trend

The graph below shows the total number of articles in wearable cardioverter-defibrillator applications in cardiac arrhythmias across all publications each year (not limited to Nature Index journals).

Technical terms

Wearable cardioverter-defibrillator (WCD): An external vest-style device that continuously monitors cardiac rhythm and delivers shocks to terminate ventricular tachycardia or fibrillation.

Ventricular tachyarrhythmia: A rapid and potentially fatal abnormal rhythm originating in the heart’s ventricles, including ventricular tachycardia and ventricular fibrillation.

Left ventricular ejection fraction (LVEF): The proportion of blood ejected from the left ventricle with each heartbeat, expressed as a percentage and used to assess cardiac pumping function.

Implantable cardioverter-defibrillator (ICD): A surgically implanted device that detects and terminates life-threatening cardiac arrhythmias via electrical shocks or pacing.

References

1. Wearable cardioverter defibrillator after ICD-system explantation: data from a multicenter registry. Scientific Reports (2025).
2. Real life experience with the wearable cardioverter-defibrillator in an international multicenter Registry. Scientific Reports (2022).
3. Therapy duration and improvement of ventricular function in de novo heart failure: the Heart Failure Optimization study. European Heart Journal (2024).
4. Ventricular arrhythmias and haemodynamic collapse during acute coronary syndrome: increased risk for sudden cardiac death?. European Journal of Preventive Cardiology (2024).