Abstract

The wearable cardioverter-defibrillator (WCD), or LifeVest (ZOLL Medical Corporation, an Asahi Kasei company, Tokyo, Japan), is designed for continuous monitoring and immediate treatment of patients at high risk of sudden cardiac arrest (SCA). Due to a lack of water resistance and inability to operate safely in wet conditions, current guidelines recommend wearing the device at all times except for short periods, such as during showering. We present the case of an 88-year-old male with complex coronary artery disease, ischemic cardiomyopathy, and permanent atrial fibrillation who experienced cardiac arrest and ventricular fibrillation (V-Fib) during a shower when not wearing his LifeVest. Immediately after he lost consciousness, his wife promptly reattached the LifeVest, which stabilized his condition with a shock delivered by the device. This case highlights potential risks during device-free periods and the limited data on compliance and outcomes in these intervals. Further study is needed to assess risks and explore solutions that allow for the device's removal for short periods and enhance the patient’s safety.

Introduction

The wearable cardioverter-defibrillator (WCD), commonly known as the LifeVest (ZOLL Medical Corporation, an Asahi Kasei company, Tokyo, Japan), provides continuous monitoring and immediate treatment for patients at high risk of sudden cardiac arrest (SCA) and serves as a bridge to ICD implantation or during early recovery when immediate placement is not feasible [1-3]. Current guidelines recommend that patients should wear the device continuously to ensure maximum protection against sudden cardiac arrest, but the device can be removed for short periods during activities such as showering or bathing [4]. Despite the recommended consistent use of the device, there have been cases witnessed where patients encountered unexpected adverse cardiac events during device-off periods. The VEST trial indicated that 64% of arrhythmic deaths in patients assigned to the WCD occurred when the device was not being worn

We discuss a case involving a patient with a history of complex cardiovascular disease who experienced cardiac arrest and ventricular fibrillation (V-fib) during showering when not wearing his LifeVest.

Case Presentation

An 88-year-old male with a history of coronary artery disease (CAD), systolic heart failure with the left ventricular ejection fraction (LVEF) of 15-20%, and permanent atrial fibrillation underwent multiple percutaneous coronary interventions (PCIs) with stent placements in the right coronary artery (RCA) and left anterior descending (LAD) artery. Due to his severe cardiac conditions and high risk of ventricular arrhythmias, he was prescribed a LifeVest, and he wore it continuously until he received an implantable cardioverter-defibrillator (ICD) two weeks later.

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