The wearable cardioverter defibrillator as a bridge to implantable defibrillator post myocardial infarction: what do we know?

Introduction: Ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) can lead to aborted cardiac arrest or sudden cardiac death in patients with poor left ventricular function early after acute myocardial infarction (AMI). Although it has been shown that the implantable cardioverter defibrillator (ICD) can treat ventricular tachyarrhythmias and save lives in patients with ischemic cardiomyopathy, it’s use during the early phase post AMI has not been shown to reduce mortality. Current device guidelines require a waiting period of 40 days post AMI and 3 months post revascularization. Thus, there is a time gap where high-risk patients may not be protected. Areas covered: This review summarizes the characteristics of the wearable cardioverter-defibrillator (WCD) and its role in bridging the gap between an AMI and time of ICD eligibility. In addition, we focus on the efficacy of the WCD in treating ventricular tachyarrhythmias events, compliance and safety of the WCD use. Expert commentary: The WCD use during the early post AMI period can add crucial information to the process of risk stratification and decision-making whether an individual needs an implantation of an ICD or not. The WCD can serve as a safe and effective bridge during the interval preceding ICD placement.