Introduction
It is well known that an implantable cardioverter-defibrillator (ICD)
improves survival and reduces the mortality rate due to ventricular
tachyarrhythmias [1-3]. The Danish Cardiac Arrest Registry showed
the superiority of early implantation of ICD in patients surviving
myocardial infarction (MI) with cardiac arrest [4]. However, some
patients do not meet the criteria for ICD implantation or are unable to
receive an implantable device such as patients in the acute phase of MI
or myocarditis. The wearable cardioverter defibrillator (WCD) may be
considered to protect these patients against malignant ventricular
tachyarrhythmias and as a bridge to decision for ICD implantation
[5]. However, compliance is impaired due to comfort issues [6].
Poor compliance and obesity decreased the efficacy of WCD therapy
[7]. In addition, the VEST trial showed no reduction of arrhythmic
death as the primary endpoint in recent MI patients with reduced left
ventricular ejection fraction (LVEF < 35%) [8].
One cohort study on sudden cardiac death (SCD) reported that WCD
treatment is effective in females with a first shock success rate of
95% [9]. WEARIT-II-Registry presented a higher rate of ventricular
and atrial arrhythmic events in females as compared to males [10].
However, randomized controlled trials and further data on gender
differences are lacking. Therefore, we analyzed in a multicenter setting
a consecutive patient cohort wearing WCD to explore gender differences
regarding compliance, rate of appropriate WCD shocks, and mortality.