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Original article

Vol. 150 No. 3940 (2020)

Use of the wearable cardioverter-defibrillator – the Swiss experience

Cite this as:
Swiss Med Wkly. 2020;150:w20343



Sudden cardiac death caused by malignant arrhythmia can be prevented by the use of defibrillators. Although the wearable cardioverter defibrillator (WCD) can prevent such an event, its role in clinical practice is ill defined. We investigated the use of the WCD in Switzerland with emphasis on prescription rate, therapy adherence and treatment rate.


The Swiss WCD Registry is a retrospective observational registry including patients using a WCD. Patients were included from the first WCD use in Switzerland until February 2018. Baseline characteristics and data on WCD usage were examined for the total study population, and separately for each hospital.


From 1 December 2011 to 18 February 2018, a total of 456 patients (67.1% of all WCDs prescribed in Switzerland and 81.1% of all prescribed in the participating hospitals) were included in the registry. Up to 2017 there was a yearly increase in the number of prescribed WCDs to a maximum of 271 prescriptions per year. The mean age of patients was 57 years (± 14), 81 (17.8%) were female and mean left ventricular ejection fraction (EF) was 32% (± 13). The most common indications for WCD use were new-onset ischaemic cardiomyopathy (ICM) with EF ≤35% (206 patients, 45.2%), new-onset nonischaemic cardiomyopathy (NICM) with EF ≤35% (115 patients, 25.2%), unknown arrhythmic risk (83 patients, 18.2%), bridging to implantable cardioverter-defibrillator implantation or heart transplant (37 patients, 8.1%) and congenital/inherited heart disease (15 patients, 3.3%). Median wear duration was 58 days (interquartile range [IQR] 31–94) with a median average daily wear time of 22.6 hours (IQR 20–23.2). Seventeen appropriate therapies from the WCD were delivered in the whole population (treatment rate: 3.7%) to a total of 12 patients (2.6% of all patients). The most common underlying heart disease in patients with a treatment was ICM (13/17, 76.5%). There were no inappropriate treatments.


The use of WCDs has increased in Switzerland over the years for a variety of indications. There is high therapy adherence to the WCD, and a treatment rate comparable to previously published registry data.


  1. Todesursachenstatistik 2017, Bundesamt für Statistik, 16.12.2019. Available from 2019;1–2.
  2. Auricchio A, Klein H, Geller CJ, Reek S, Heilman MS, Szymkiewicz SJ. Clinical efficacy of the wearable cardioverter-defibrillator in acutely terminating episodes of ventricular fibrillation. Am J Cardiol. 1998;81(10):1253–6. doi:.
  3. MiGeL yearly report. Available from 2020
  4. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al.; ESC Scientific Document Group. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793–867. doi:.
  5. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. doi:.
  6. Kovacs B, Reek S, Saguner AM, Krasniqi N, Eriksson U, Duru F. Outcomes during and after the use of the wearable cardioverter-defibrillator in a tertiary-care and a regional hospital in Switzerland. Swiss Med Wkly. 2019;149:w20136. doi:.
  7. Kovacs B, Reek S, Krasniqi N, Eriksson U, Duru F. Die tragbare Defibrillatorweste. Swiss Med Forum. 2018;18:509–12. doi:
  8. Masri A, Altibi AM, Erqou S, Zmaili MA, Saleh A, Al-Adham R, et al. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol. 2019;5(2):152–61. doi:.
  9. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al.; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83. doi:.
  10. Solomon SD, Zelenkofske S, McMurray JJV, Finn PV, Velazquez E, Ertl G, et al.; Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med. 2005;352(25):2581–8. doi:.
  11. Kuck KH, Cappato R, Siebels J, Rüppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000;102(7):748–54. doi:.
  12. Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS, et al. Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000;101(11):1297–302. doi:.
  13. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G ; Multicenter Unsustained Tachycardia Trial Investigators. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med. 1999;341(25):1882–90. doi:.
  14. Wyse DG, Friedman PL, Epstein AE ; Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337(22):1576–84. doi:.
  15. Ellenbogen KA, Koneru JN, Sharma PS, Deshpande S, Wan C, Szymkiewicz SJ. Benefit of the Wearable Cardioverter-Defibrillator in Protecting Patients After Implantable-Cardioverter Defibrillator Explant: Results From the National Registry. JACC Clin Electrophysiol. 2017;3(3):243–50. doi:.
  16. Zishiri ET, Williams S, Cronin EM, Blackstone EH, Ellis SG, Roselli EE, et al. Early risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction and potential role of the wearable cardioverter defibrillator. Circ Arrhythm Electrophysiol. 2013;6(1):117–28. doi:.
  17. Kutyifa V, Moss AJ, Klein H, Biton Y, McNitt S, MacKecknie B, et al. Use of the wearable cardioverter defibrillator in high-risk cardiac patients: data from the Prospective Registry of Patients Using the Wearable Cardioverter Defibrillator (WEARIT-II Registry). Circulation. 2015;132(17):1613–9. doi:.
  18. Chung MK, Szymkiewicz SJ, Shao M, Zishiri E, Niebauer MJ, Lindsay BD, et al. Aggregate national experience with the wearable cardioverter-defibrillator: event rates, compliance, and survival. J Am Coll Cardiol. 2010;56(3):194–203. doi:.
  19. Opreanu M, Wan C, Singh V, Salehi N, Ahmad J, Szymkiewicz SJ, et al. Wearable cardioverter-defibrillator as a bridge to cardiac transplantation: A national database analysis. J Heart Lung Transplant. 2015;34(10):1305–9. doi:.
  20. Erath JW, Vamos M, Sirat AS, Hohnloser SH. The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients. Clin Res Cardiol. 2017;106(4):300–6. doi:.
  21. Lamichhane M, Gardiner JC, Bianco NR, Szymkiewicz SJ, Thakur RK. National experience with long-term use of the wearable cardioverter defibrillator in patients with cardiomyopathy. J Interv Card Electrophysiol. 2017;48(1):11–9. doi:.
  22. Wäßnig NK, Günther M, Quick S, Pfluecke C, Rottstädt F, Szymkiewicz SJ, et al. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death. Circulation. 2016;134(9):635–43. doi:.
  23. Epstein AE, Abraham WT, Bianco NR, Kern KB, Mirro M, Rao SV, et al. Wearable cardioverter-defibrillator use in patients perceived to be at high risk early post-myocardial infarction. J Am Coll Cardiol. 2013;62(21):2000–7. doi:.
  24. Olgin JE, Pletcher MJ, Vittinghoff E, Wranicz J, Malik R, Morin DP, et al.; VEST Investigators. Wearable Cardioverter-Defibrillator after Myocardial Infarction. N Engl J Med. 2018;379(13):1205–15. doi:.
  25. Bloch Thomsen PE, Jons C, Raatikainen MJP, Moerch Joergensen R, Hartikainen J, Virtanen V, et al.; Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) Study Group. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study. Circulation. 2010;122(13):1258–64. doi:.
  26. Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, et al.; DINAMIT Investigators. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004;351(24):2481–8. doi:.
  27. Duncker D, König T, Hohmann S, Bauersachs J, Veltmann C. Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator-The PROLONG Study. J Am Heart Assoc. 2017;6(1):e004512. doi:.
  28. Duncker D, König T, Hohmann S, Bauersachs J, Veltmann C. Ventricular arrhythmias in patients with newly diagnosed nonischemic cardiomyopathy: Insights from the PROLONG study. Clin Cardiol. 2017;40(8):586–90. doi:.
  29. Saltzberg MT, Szymkiewicz S, Bianco NR. Characteristics and outcomes of peripartum versus nonperipartum cardiomyopathy in women using a wearable cardiac defibrillator. J Card Fail. 2012;18(1):21–7. doi:.
  30. Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, et al.; DANISH Investigators. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med. 2016;375(13):1221–30. doi:.
  31. Shun-Shin MJ, Zheng SL, Cole GD, Howard JP, Whinnett ZI, Francis DP. Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials. Eur Heart J. 2017;38(22):1738–46. doi:.
  32. Kutyifa V, Vermilye K, Daimee UA, McNitt S, Klein H, Moss AJ. Extended use of the wearable cardioverter-defibrillator in patients at risk for sudden cardiac death. Europace. 2018;20(FI2):f225–32. doi:.
  33. Kovacs B, Reek S, Krasniqi N, Eriksson U, Duru F. Extended Use of the Wearable Cardioverter-Defibrillator: Which Patients Are Most Likely to Benefit? Cardiol Res Pract. 2018;2018:7373610. doi:.
  34. Al-Khatib SM, Pokorney SD. Knowledge and Insights Vested in Us by the VEST. Circulation. 2018;138(24):2735–7. doi:.
  35. Olgin JE, Lee BK, Vittinghoff E, Morin DP, Zweibel S, Rashba E, et al. Impact of wearable cardioverter-defibrillator compliance on outcomes in the VEST trial: As-treated and per-protocol analyses. J Cardiovasc Electrophysiol. 2020;31(5):1009–18. doi:.
  36. Olgin JE, Lee BK, Vittinghoff E, Morin DP, Zweibel S, Rashba E, et al. Impact of wearable cardioverter-defibrillator compliance on outcomes in the VEST trial: As-treated and per-protocol analyses. J Cardiovasc Electrophysiol. 2020;31(5):1009–18. doi:.
  37. Leyton-Mange JS, Hucker WJ, Mihatov N, Reynolds M, Albert C, Lubitz SA, et al. Experience With Wearable Cardioverter-Defibrillators at 2 Academic Medical Centers. JACC Clin Electrophysiol. 2018;4(2):231–9. doi:.
  38. Rosenkaimer SL, El-Battrawy I, Dreher TC, Gerhards S, Röger S, Kuschyk J, et al. The Wearable Cardioverter-Defibrillator: Experience in 153 Patients and a Long-Term Follow-Up. J Clin Med. 2020;9(3):893. doi:.

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