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    Guideline recommendations

    Review the recommendations for the wearable cardioverter defibrillator (WCD), as well as additional guidelines for the care of patients at risk for sudden cardiac death (SCD).

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    Update of the ESC Guidelines

    ESC HF Guidelines 2021 and ESC VT/VF Guidelines 2022

    Summary of recommendations for LifeVest:

    • NICM and ICM patients with heart failure are categorised with a class IIb (level B) recommendation in the ESC HF guidelines (2021)1
    • The recommendation for secondary prophylaxis remains class IIa (level C)2
    • For patients awaiting a heart transplant, the recommendation remains Class IIb (Level C)2

    Ischaemic and Non-ischaemic

    2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 1

    Ischaemic and Non-ischaemic ESC Guidelines

    Ischaemic

    2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.2 The WCD may be considered in the early phase after MI in selected patients.

    Ischaemic ESC Guideline

    Recommendations for managing the risk of SCD

    • At least 3 months of OMT before an ICD should be considered
    • LVEF to determine the risk of SCD confirmed
    • The highest risk of SCD is in the first few weeks after a STEMI, especially in patients with reduced LVEF (ESC VT/VF Guidelines 2022)

    ESC HF guidelines 20211

    ESC HF guidelines 2021

    ESC VT/VF Guidelines 20222

    ESC VT/VF Guidelines 2022

    Further International Guidelines

    AHA/ACC/HRS Guidelines 20175

    • Use of the WCD is supported with evidence level B-NR.
    • The recommendation to consider WCD in ischaemic and non-ischaemic patients is equally supported in the guidelines.
    • Joint decision-making with patients in favour of WCD treatment is a Class I recommendation.

    View the guidelines

    EHRA 20166

    • The WCD offers protection against SCD in the guideline-recommended waiting period and thus supports risk stratification based on the long-term risk of SCD
    • The clinical benefit of the WCD is made up of the number of arrhythmias converted, the number of successful risk assessments and the number of unnecessary ICD implantations prevented.

    View the guidelines

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientifi c Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Oct 14;: PMID: 34447992.
    2. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by 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 the Association for European Paediatric and Congenital Cardiology (AEPC), European Heart Journal, 2022;, ehac262, https://doi. org/10.1093/eurheartj/ehac262
    3. Deneke, T., Bosch, R., Eckardt, L. et al. Kardiologe (2019). https://doi.org/10.1007/s12181-019-0331-4.
    4. Burger H, Schmitt J, Knaut M, et al. Z Herz-Thorax-Gefäßchir (2018)32:286. https://doi.org/10.1007/s00398-018-0246-6.
    5. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. Circulation 2017;CIR.0000000000000549.
    6. Reek et al. Europace 2017 (19):335–345.

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