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Wearable Cardioverter-Defibrillator in Adult Congenital Heart Disease: A Bridge to Decision, Recovery, and Advanced

Berardo Sarubbi1,2, Anna Murredda3, Giovanni Domenico Ciriello3

  • 1Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit, Monaldi Hospital, Via Leonardo Bianchi, Naples, 80131, Italy. berardo.sarubbi@collaboratore.uniparthenope.it.

Heart Failure Reviews
|May 25, 2026
PubMed

Insights

Sudden cardiac death (SCD) is a risk for adults with congenital heart disease (ACHD). The wearable cardioverter-defibrillator (WCD) offers temporary protection, aiding assessment before permanent device decisions.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Adult Congenital Heart Disease (ACHD)

Background:

  • Sudden cardiac death (SCD) is a significant cause of mortality in adults with congenital heart disease (ACHD).
  • Risk stratification for ventricular arrhythmias in ACHD is complex due to anatomical and hemodynamic heterogeneity.
  • Implantable cardioverter-defibrillator (ICD) implantation in ACHD patients faces challenges like anatomical constraints and device complications.

Purpose of the Study:

  • To review the rationale, evidence, and clinical applications of wearable cardioverter-defibrillator (WCD) therapy in ACHD.
  • To explore WCD as a temporary solution for arrhythmic risk in ACHD patients with transient conditions.
  • To guide decision-making regarding permanent ICD implantation in complex ACHD cases.

Main Methods:

  • Literature review of pathophysiological mechanisms and clinical evidence for WCD use in ACHD.
  • Analysis of WCD's role in managing temporary increases in arrhythmic risk or impaired ventricular function.
  • Discussion of WCD's utility in allowing clinical stabilization and reassessment.

Main Results:

  • WCD provides non-invasive, temporary protection against life-threatening ventricular arrhythmias.
  • It allows time for stabilization and reassessment in ACHD patients with fluctuating risk.
  • WCD can mitigate risks associated with premature or uncertain ICD indications.

Conclusions:

  • Wearable cardioverter-defibrillator (WCD) therapy presents a viable non-invasive option for temporary arrhythmia protection in ACHD.
  • WCD facilitates individualized decision-making for permanent device therapy in this challenging population.
  • Further research into WCD efficacy and long-term outcomes in ACHD is warranted.

Keywords:
Adult congenital heart diseaseSudden cardiac deathVentricular arrhythmiasWearable cardioverter defibrillator

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