Sudden Cardiac Death

Proven Therapy for Patients at Early Risk of Sudden Cardiac Death

The risk of sudden cardiac death (SCD) or serious cardiac arrhythmias in patients with heart failure is particularly high in the initial period after an acute cardiac event. 1,2 Also the clinical condition of patients often changes during this time.3 Therefore the medication is optimally adjusted in accordance with guideline recommendations before a decision is made on the necessity of further long-term therapy, such as the implantation of an implantable cardioverter defibrillator (ICD). 4

Left-ventricular ejection fraction (LVEF) is still the most reliable predictor of this risk. According to the guidelines of the European Society of Cardiology (ESC) and of the American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS), patients with an LVEF ≤ 35% after an acute cardiac event should be considered for a wearable cardioverter defibrillator (WCD; LifeVest® ZOLL CMS) during the three-month drug therapy optimization phase. 4, 5, 6 This approach is supported by extensive evidence, including data from more than 20,000 patients from retrospective and prospective registries and a large randomized controlled trial, demonstrating the clinical effectiveness of the WCD in terminating ventricular tachyarrhythmias.1, 7-11 The median wearing time in the most recent European registries were above 23 hours daily. 9, 12

The LifeVest wearable cardioverter defibrillator is a treatment option for patients at risk of sudden cardiac death that can offer advanced protection and monitoring during the early period after a cardiac event while medical therapy is being optimized and permanent risk is established. Unlike an ICD, LifeVest is worn outside the body rather than implanted in the chest. LifeVest is designed to continuously monitor a patient’s heart, detect certain life-threatening rapid heart rhythms, and automatically deliver a treatment shock to restore normal heart rhythm.

Prof Christian Perings

The Sudden Cardiac Death section is supported by ZOLL

Prof Christian Perings

Section advisor

Prof Christian Perings

Featured Articles Article icon

Diagnosis And Therapy Of Cardiac Sarcoidosis: A Clinical Perspective

US Cardiology Review 2019;13(1):41–5

Monomorphic Ventricular Arrhythmias In Athletes

Arrhythmia & Electrophysiology Review 2019;8(2):83–9.

Preventive Ventricular Tachycardia Ablation In Patients With Ischaemic Cardiomyopathy: Meta-Analysis Of Randomised Trials

Arrhythmia & Electrophysiology Review 2019;8(3):173–9.

Arrhythmogenic Cardiomyopathy: A Disease Or Merely A Phenotype?

European Cardiology Review 2020;15:e11.

The Limitations Of Symptom-Based Heart Failure Management

Cardiac Failure Review 2019;5(2):74–7.

Right Ventricular Failure: Pathophysiology, Diagnosis And Treatment

Cardiac Failure Review 2019;5(3):140–6.

Unmasking Adenosine: The Purinergic Signalling Molecule Critical To Arrhythmia Pathophysiology And Management

Arrhythmia & Electrophysiology Review 2019;8(4):240–8.

Use of the wearable cardioverter defibrillator in high-risk cardiac patients: data from the Prospective Registry of Patients Using the Wearable Cardioverter Defibrillator (WEARIT-II Registry)

Kutyifa V, Moss AJ, Klein H, et al. Circulation 2015;132:1613–9.

Experience with the wearable cardioverter-defibrillator in patients at high risk for sudden cardiac death

Wäßnig NK, Günther M, Quick S, et al. Circulation 2016;134:635–43.

Sudden cardiac death in patients with myocarditis: evaluation, risk stratification, and management

Ali-Ahmed F, Dalgaard F, Al-Khatib SM. Am Heart J 2020;220:29–40.

Avoiding untimely implantable cardioverter/defibrillator implantation by intensified heart failure therapy optimization supported by the wearable cardioverter/defibrillator—the PROLONG study

Duncker D, König T, Hohmann S, et al. J Am Heart Assoc 2017;6.

Current challenges in sudden cardiac death prevention

Corrado D, Zorzi A, Vanoli E, Gronda E. Heart Fail Rev 2020;25:99–106.

One‐year follow‐up of the prospective registry of patients using the wearable defibrillator (WEARIT‐II Registry)

Kutyifa V, Moss AJ, Klein HU, et al. Pacing Clin Electrophysiol 2018;41:1307–13.

Guideline-concordant-phenotyping: identifying patient indications for implantable cardioverter defibrillators from electronic health records

Manrodt C, Curtis AB, Soderlund D, Fonarow GC. Int J Med Inform 2020;138:104138.

Wearable cardioverter-defibrillators: a review of evidence and indications

Cheung CC, Olgin JE, Lee BK. Trends Cardiovasc Med 2020; epub ahead of press.

Regional variation of mortality in heart failure with reduced and preserved ejection fraction across Asia: outcomes in the ASIAN‐HF registry

MacDonald MR, Tay WT, Teng THK, et al. J Am Heart Assoc 2020;9.

One‐year mortality after implantable cardioverter‐defibrillator placement within the Veterans Affairs Health System

Fudim M, Carlisle MA, Devaraj S, et al. Eur J Heart Fail 2020;22:859–67.

Implantable cardioverter–defibrillators in trials of drug therapy for heart failure: a systematic review and meta‐analysis

Gama F, Ferreira J, Carmo J, et al. J Am Heart Assoc 2020;9.

Long-Term Follow-Up of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator: The DAI-T4F Nationwide Registry

Waldmann V, Bouzeman A, Duthoit G, et al. Circulation 2020;142:1612–22.

Sudden cardiac death among persons with diabetes aged 1–49 years: a 10-year nationwide study of 14 294 deaths in Denmark

Lynge TH, Svane J, Pedersen-Bjergaard U, et al. Eur Heart J 2020;41:2699–706.

Outcomes following implantable cardioverter–defibrillator generator replacement in adults: a systematic review

McCarthy KJ, Locke AH, Coletti M, et al. Heart Rhythm 2020;17:1036–42.

Genetic susceptibility for COVID-19–associated sudden cardiac death in African Americans

Giudicessi JR, Roden DM, Wilde AAM, Ackerman MJ. Heart Rhythm 2020;17:1487–92.

Wearable cardioverter-defibrillator in patients with a transient risk of sudden cardiac death: the WEARIT-France cohort study

Garcia R, Combes N, Defaye P, et al. EP Europace 2020.

Prediction of sudden cardiac death in implantable cardioverter defibrillators: a review and comparative study of heart rate variability features

Parsi A, O’Loughlin D, Glavin M, Jones E. IEEE Rev Biomed Eng 2020;13:5–16.

Blood pressure, hypertension and the risk of sudden cardiac death: a systematic review and meta-analysis of cohort studies

Pan H, Hibino M, Kobeissi E, Aune D. Eur J Epidemiol 2020;35:443–54.

Classic and novel biomarkers as potential predictors of ventricular arrhythmias and sudden cardiac death

Shomanova Z, Ohnewein B, Schernthaner C, et al. J Clin Med 2020;9:578.

Association between malignant mitral valve prolapse and sudden cardiac death: a review

Muthukumar L, Jahangir A, Jan MF, et al. JAMA Cardiol 2020;5:1053–61.

Another shock for sudden death prevention after myocardial infarction

Field ME, Page RL. N Engl J Med 2018;379:1274–5.

Sudden cardiac death in ischemic heart disease: from imaging arrhythmogenic substrate to guiding therapies

Gräni C, Benz DC, Gupta S, et al. JACC Cardiovasc Imaging 2020;13:2223–38.

The wearable cardioverter-defibrillator: experience in 153 patients and a long-term follow-up

Rosenkaimer SL, El-Battrawy I, Dreher TC, et al. J Clin Med 2020;9:893.

Dose-response association of implantable device-measured physical activity with long-term cardiac death and all-cause mortality in patients at high risk of sudden cardiac death: a cohort study

Li X, Zhao S, Chen K, et al. Int J Behav Nutr Phys Act 2020;17:119.

Association between atrial fibrillation and sudden cardiac death: pathophysiological and epidemiological insights

Waldmann V, Jouven X, Narayanan K, et al. Circ Res 2020;127:301–9.

T-peak to T-end improvements after beta-blocker administration in peripartum cardiomyopathy patients

Achmad C, Iqbal M, Karwiky G, et al. Cardiol Res 2020;11:185–91.

COVID-19, clinical trials, and QT-prolonging prophylactic therapy in healthy subjects: first, do no harm

Gollob MH. J Am Coll Cardiol 2020;75:3184–6.

Sacubitril/valsartan and sudden cardiac death according to implantable cardioverter-defibrillator use and heart failure cause: a PARADIGM-HF analysis

Rohde LE, Chatterjee NA, Vaduganathan M, et al. JACC Heart Fail 2020;8:844–55.

Emerging techniques for risk stratification in nonischemic dilated cardiomyopathy: JACC review topic of the week

Marrow BA, Cook SA, Prasad SK, McCann GP. J Am Coll Cardiol 2020;75:1196–207.

Periprocedural risk and survival associated with implantable cardioverter-defibrillator placement in older patients with advanced heart failure

Fudim M, Ali-Ahmed F, Parzynski CS, et al. JAMA Cardiol 2020;5:643–51.

Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators

Junttila MJ, Pelli A, Kenttä TV, et al. Diabetes Care 2020;43:196–200.

Epidemiology of inherited arrhythmias

Offerhaus JA, Bezzina CR, Wilde AAM. Nat Rev Cardiol 2020;17:205–15.

Sudden cardiac death as first manifestation of heart disease in women: the Oregon sudden unexpected death study, 2004–2016

Reinier K, Stecker EC, Uy-Evanado A, et al. Circulation 2020;141:606–8.

Mode of death among Japanese adults with heart failure with preserved, midrange, and reduced ejection fraction

Kitai T, Miyakoshi C, Morimoto T, et al. JAMA Netw Open 2020;3:e204296.

Right ventricular electromechanical abnormalities in Brugada syndrome: is this a cardiomyopathy?

Pappone C, Monasky MM, Micaglio E, Ciconte G. Eur Heart J Suppl 2020;22:e101–4.

Association of azithromycin use with cardiovascular mortality

Zaroff JG, Cheetham TC, Palmetto N, et al. JAMA Netw Open 2020;3:e208199.

Vulnerable plaques and patients: state-of-the-art

Tomaniak M, Katagiri Y, Modolo R, et al. Eur Heart J 2020;41:2997–3004.

Ventricular arrhythmias in myocarditis: characterization and relationships with myocardial inflammation

Peretto G, Sala S, Rizzo S, et al. J Am Coll Cardiol 2020;75:1046–57.

The role of genetics in cardiovascular disease: arrhythmogenic cardiomyopathy

James CA, Syrris P, van Tintelen JP, Calkins H. Eur Heart J 2020;41:1393–400.

Long-term outcomes of implantable cardioverter-defibrillator therapy in the SCD-HeFT

Poole JE, Olshansky B, Mark DB, et al. J Am Coll Cardiol 2020;76:405–15.

Occult overdose masquerading as sudden cardiac death: from the POstmortem Systematic InvesTigation of Sudden Cardiac Death study

Rodriguez RM, Montoy JCC, Repplinger D, et al. Ann Intern Med 2020;173:941–4.

Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review

Barra S, Providência R, Narayanan K, et al. Eur Heart J 2020;41:1976–86.

GSTM3 variant is a novel genetic modifier in Brugada syndrome, a disease with risk of sudden cardiac death

Juang JMJ, Binda A, Lee SJ, et al. EBioMedicine 2020;57:102843.

Genetic variants as sudden-death risk markers in inherited arrhythmogenic syndromes: personalized genetic interpretation

Campuzano O, Sarquella-Brugada G, Arbelo E, et al. J Clin Med 2020;9:1866.

Handgrip strength is inversely associated with sudden cardiac death

Laukkanen JA, Voutilainen A, Kurl S, et al. Mayo Clin Proc 2020;95:825–8.

Association between pulse pressure and the risk of sudden cardiac death in middle-aged men: a 26-year follow-up population-based study

Jae SY, Kurl S, Kunutsor SK, et al. Mayo Clin Proc 2020;95:2044–6.

Getting to the heart of sudden cardiac death

Official Joint Session. 2020.

Detection of hypertrophic cardiomyopathy using a convolutional neural network-enabled electrocardiogram

Ko WY, Siontis KC, Attia ZI, et al. J Am Coll Cardiol 2020;75:722–33.

A randomized trial of subcutaneous versus transvenous defibrillator therapy: the PRAETORIAN trial

Knops R. 2020.

Effect of sacubitril/valsartan on left ventricular ejection fraction and potential impact on ICD implant rates for primary prevention of sudden cardiac death: the SAVE-ICD study

Guerra, F. 2020.

EPA levels and cardiovascular outcomes in the Reduction of Cardiovascular Events with Icosapent Ethyl – Intervention Trial

Bhatt DL, Miller M, Steg G, et al. 2020.

Characterization of clinically relevant copy-number variants from exomes of patients with inherited heart disease and unexplained sudden cardiac death

Singer ES, Ross SB, Skinner JR, et al. Genet Med 2020; epub ahead of press.

Arrhythmogenic late Ca2+ sparks in failing heart cells and their control by action potential configuration

Fowler ED, Wang N, Hezzell M, et al. Proc Natl Acad Sci U S A 2020;117:2687–92.

T1 mapping tissue heterogeneity provides improved risk stratification for ICDs without needing gadolinium in patients with dilated cardiomyopathy

Nakamori S, Ngo LH, Rodriguez J, et al. JACC Cardiovasc Imaging 2020;13:1917–30.

Impact of wearable cardioverter‐defibrillator compliance on outcomes in the VEST trial: as‐treated and per‐protocol analyses

Olgin JE, Lee BK, Vittinghoff E, et al. J Cardiovasc Electrophysiol 2020;31:1009–18.

Predictors of sudden cardiac death in high‐risk patients following a myocardial infarction

Docherty KF, Ferreira JP, Sharma A, et al. Eur J Heart Fail 2020;22:848–55.

Wearable cardioverter–defibrillator after myocardial infarction

Olgin JE, Pletcher MJ, Vittinghoff E, et al. N Engl J Med 2018;379:1205–15.

Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial (PAUSE-SCD): rationale and study design

Chen M, Wu S, Yao Y, et al. J Interv Card Electrophysiol 2020;57:271–8.

Placebo-controlled, double-blind study of empagliflozin (EMPA) and implantable cardioverter-defibrillator (EMPA-ICD) in patients with type 2 diabetes (T2DM): rationale and design

Fujiki S, Iijima K, Okabe M, et al. Diabetes Ther 2020;11:2739–55.

Declining clinical benefit of ICD in heart failure patients: temporal trend of mortality outcomes from randomized controlled trials

Disertori M, Masè M, Rigoni M, et al. J Cardiol 2020;75:148–54.

Design of the SILICOFCM study: effect of sacubitril/valsartan vs lifestyle intervention on functional capacity in patients with hypertrophic cardiomyopathy

Tafelmeier M, Baessler A, Wagner S, et al. Clin Cardiol 2020;43:430–40.

Evaluation of a novel educational intervention to improve conversations about implantable cardioverter-defibrillators management in patients with advanced heart failure

Kwok IB, Mather H, McKendrick K, et al. J Palliat Med 2020;23:1619–25.

Effect of four classes of antihypertensive drugs on cardiac repolarization heterogeneity: a double-blind rotational study

Sánez Tähtisalo H, Hiltunen TP, Kenttä T, et al. PLoS One 2020;15:e0230655.

EMERGEncy versus delayed coronary angiogram in survivors of out-of-hospital cardiac arrest with no obvious non-cardiac cause of arrest: design of the EMERGE trial

Hauw-Berlemont C, Lamhaut L, Diehl JL, et al. Am Heart J 2020;222:131–8.

Myocardial minimal Damage after rapid ventricular pacing – the prospective randomized multicentre MyDate-Trial

Semmler V, Deutschmann C, Haller B, et al. Sci Rep 2020;10:4753.

Subcutaneous or transvenous defibrillator therapy

Knops RE, Olde Nordkamp LRA, Delnoy PPHM, et al. N Engl J Med 2020;383:526–36.

A validated model for sudden cardiac death risk prediction in pediatric hypertrophic cardiomyopathy

Miron A, Lafreniere-Roula M, Fan CPS, et al. Circulation 2020;142:217–29.

The impact of wearable cardioverter-defibrillator use on long-term decision for implantation of a cardioverter-defibrillator in a semirural acute care hospital

Sinha AM, Bense J, Hohenforst-Schmidt W. J Interv Card Electrophysiol 2020.

Inherited cardiac arrhythmias

Schwartz PJ, Ackerman MJ, Antzelevitch C, et al. Nat Rev Dis Primers 2020;6:58.

The Impact of Ethnicity on Cardiac Adaptation

European Cardiology Review 2020;15:e61.

Diagnosis and Management of Anomalous Coronary Arteries with a Malignant Course

Interventional Cardiology Review 2019;14(2):83–8.

Insights for Stratification of Risk in Brugada Syndrome

European Cardiology Review 2019;14(1):45–9

A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk

Arrhythmia & Electrophysiology Review 2019;8(2):90–8.

British Heart Rhythm Society Clinical Practice Guidelines on the Management of Patients Developing QT Prolongation on Antipsychotic Medication

Arrhythmia & Electrophysiology Review 2019;8(3):161–5.

The Increment of Short-term Variability of Repolarisation Determines the Severity of the Imminent Arrhythmic Outcome

Arrhythmia & Electrophysiology Review 2019;8(3):166–72.

The Role of Cardiac MRI in the Management of Ventricular Arrhythmias in Ischaemic and Non-ischaemic Dilated Cardiomyopathy

Arrhythmia & Electrophysiology Review 2019;8(3):191–201.

Current Controversies and Challenges in Brugada Syndrome

European Cardiology Review 2019;14(3):169–74

Brugada Syndrome: Progress in Diagnosis and Management

Arrhythmia & Electrophysiology Review 2019;8(1):13–8

Brugada Syndrome: Progress in Genetics, Risk Stratification and Management

Arrhythmia & Electrophysiology Review 2019;8(1):19–27

Conduction Abnormalities After Transcatheter Aortic Valve Replacement

US Cardiology Review, 2019;13(1):21–9

Use of Electrophysiological Studies in Transcatheter Aortic Valve Implantation

Arrhythmia & Electrophysiology Review 2020;9(1):20–7.

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. Eur Heart J 2015;36:2793–867.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)

Ponikowski P, Voors AA, Anker SD, et al. European Heart Journal 2016;37:2129–200.

Ventricular arrhythmias and the prevention of sudden cardiac death guideline update

Marzlin KM. AACN Adv Crit Care 2020;31:221–7.

The Cardiac Society of Australia and New Zealand position statement on the diagnosis and management of arrhythmogenic right ventricular cardiomyopathy (2019 update)

Hamilton-Craig C, McGavigan A, Semsarian C, et al. Heart Lung Circ 2020;29:40–8.

Subcutaneous implantable cardioverter defibrillator indication in prevention of sudden cardiac death in difficult clinical situations: a French expert position paper

Probst V, Boveda S, Sadoul N, et al. Arch Cardiovasc Dis 2020;113:359–66.

Guidance on minimizing risk of drug-induced ventricular arrhythmia during treatment of COVID-19: a statement from the Canadian Heart Rhythm Society

Sapp JL, Alqarawi W, MacIntyre CJ, et al. Can J Cardiol 2020;36:948–51.

Wearable cardioverter-defibrillator in patients at risk of sudden cardiac death: consensus document contradicts current guideline recommendations

Reif S. Europace 2020;22:1442.

State of the art: imaging for myocardial viability: a scientific statement from the American Heart Association

Garcia MJ, Kwong RY, Scherrer-Crosbie M, et al. Circ Cardiovasc Imaging 2020;13:e000053.

2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

Stiles MK, Fauchier L, Morillo CA, Wilkoff BL. Heart Rhythm 2020;17:e220–8.


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