Sudden cardiac death (SCD) prevention in patients with newly diagnosed ventricular dysfunction or heart failure with reduced ejection fraction is an important clinical issue. A lack of strong evidence has led to uncertainty in medical decision making and variable clinical practice in the use of wearable cardioverter-defibrillators (WCDs). In this context, the results of VEST (Vest Prevention of Early Sudden Death Trial)¹ at the American College of Cardiology Scientific Sessions on March 10, 2018, in Orlando, FL were highly anticipated. However, interpretations of the trial results have been presented that we find difficult to reconcile. We wish to call attention to what we think is the most rigorous interpretation of VEST: the primary results were negative.

The WCD is designed for patients at risk of SCD who are not immediate candidates for implantable cardioverter-defibrillator (ICD) therapy. This is most commonly because of a new diagnosis of left ventricular dysfunction, often after acute myocardial infarction (MI).² Although ICDs improve survival over years of treatment in appropriately selected patients, reductions in the first 40 days postinfarction have not been conclusively demonstrated.^3,4 Despite this lack of evidence, the Food and Drug Administration approved the WCD for use in 2002, primarily because of the ability of this noninvasive technology to deliver appropriate shocks in laboratory settings and case series.⁵

Although the WCD may seem benign—prompting a philosophy among some of why not, or better safe than sorry—there are reasons its efficacy and value should be …

在新诊断出的心室功能不全或心力衰竭且射血分数降低的患者中，预防心源性猝死（SCD）是重要的临床问题。缺乏有力的证据导致在使用可穿戴式心脏复律除颤器（WCD）时医疗决策的不确定性和临床实践的不确定性。在这种情况下，2018年3月10日在佛罗里达州奥兰多举行的美国心脏病学会科学会议上的VEST（预防早期猝死预防试验）¹的结果备受期待。但是，已经给出了对试验结果的解释，我们认为这很难调和。我们希望引起人们对我们认为最严格的VEST解释的注意：主要结果是负面的。

WCD专为并非SCD风险的患者而不是可植入式心脏复律除颤器（ICD）治疗的直接候选人。这是最常见的原因，通常是在急性心肌梗死（MI）后通常重新诊断为左心功能不全。²虽然ICD的改善多年来在适当选择治疗的患者存活，在第40日减少梗死尚未最终证实。^3，4尽管缺乏证据，美国食品和药物管理局批准于2002年使用的WCD，主要是因为这种非侵入性技术，在实验室的设置和病例系列提供适当的冲击的能力。⁵

尽管WCD似乎是良性的-在为什么不这样做中提倡一种哲学，或者比后悔更安全-但仍有理由说明其功效和价值应为……