Sudden Cardiac Death

Proven Therapy for Patients at Early Risk of Sudden Cardiac Death

Patients with newly diagnosed heart failure and reduced ejection fraction face a notably elevated risk of sudden cardiac death (SCD) or life-threatening arrhythmias during the first 90 days after diagnosis.^1,2 During this vulnerable early phase, clinical trials have shown that patients’ conditions often fluctuate considerably.³

Therefore, optimised guideline-recommended medical therapy (GRMT) is crucial before considering long-term interventions such as implantable cardioverter defibrillator (ICD) implantation.^4,5 Recent evidence underscores that reverse remodelling processes take time to manifest, even under modern drug therapy.^6,7

The SCD-PROTECT study further demonstrated that patients with newly diagnosed heart failure and reduced ejection fraction remain at substantial risk of sudden cardiac arrest during the early phase of GRMT – emphasising the importance of early protection and risk stratification.⁸

Section Advisor: Prof Christian Perings

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New Content

SCD-PROTECT Study

Sudden cardiac death in newly diagnosed non-ischaemic or ischaemic cardiomyopathy assessed with a wearable cardioverter-defibrillator: the German nationwide SCD-PROTECT study

Duncker D, Marijon E, Metra M, et al. Eur Heart J 2025;46:4597–606.

A Review on WCDs

A review on wearable cardioverter-defibrillators in clinical practice for sudden cardiac death prevention and heart failure management

Duncker D, Garcia R, Bonderman D, et al. Europace 2025;27:euaf257.

Featured Video

ESC HFA 25: SCD-PROTECT: SCD in New Non-ischemic Cardiomyopathy or MI/CAD

ESC HF 25 - SCD-PROTECT shows high risk of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) during early medical therapy optimization for reduced LVEF in patients with new non-ischemic cardiomyopathy or MI/CAD.

Recorded on-site at ESC HF in Belgrade, 2025.

Editors: Jonathan McKenna
Videographer: Tom Green, Mike Knight

Support: This is an independent interview produced by Radcliffe Cardiology

Guideline-directed Management of Patients at Risk of Sudden Cardiac Death

In this short interview, conducted at ESC 2022 in Barcelona, Prof David Duncker (Hannover Heart Rhythm Center, Hannover, DE) discusses the relevancy of sudden cardiac death risk, how the recent ESC guidelines protect patients, and considers recommendations for risk stratification.

Discussion topics:

1. Relevancy of sudden cardiac death risk

2. The recently published ESC guidelines

3. Recommendations for risk stratification

Location: ESC 2022, Barcelona, ES

Interviewer: Jonathan McKenna

Videos

ESC HFA 25: SCD-PROTECT

ESC HFA 25: SCD-PROTECT: Plötzlicher Herztod bei neu diagnostizierter nicht-ischämischer Kardiomyopathie oder MI/KHK

ESC HF 25 - SCD-PROTECT zeigt hohes Risiko für plötzlichen Herzstillstand (SCA) und plötzlichen Herztod (SCD) während der frühen medikamentösen Therapieoptimierung bei reduzierter LVEF bei Patienten mit neu diagnostizierter nicht-ischämischer Kardiomyopathie oder MI/KHK.

Leitliniengerechte Behandlung

Leitliniengerechte Behandlung von Patienten mit dem Risiko eines plötzlichen Herztodes

Behandelten Themen:

1. Relevanz des Risikos für den plötzlichen Herztod

2. Die kürzlich veröffentlichten ESC-Leitlinien

3. Empfehlungen für die Risikostratifizierung

SCD Risk

SCD Risk After Acute MI in 2025 – What's New?

Dr Alexander Breitenstein reviews evolving risk dynamics and guideline perspectives, emphasising the persistent vulnerability during the early post-MI period.

WICD-MI Study

What Have We Learnt From the WICD-MI Study?

Prof Christian de Chillou presents key findings from the WICD-MI registry, highlighting the potential of wearable defibrillators and tailored early-phase management.

Risk Stratification

What Besides LVEF Can We Use as Risk Predictors for SCD Long Term Risk Stratification?

Prof Gerhard Hindricks (Charite University Hospital, DE) discusses the limitations of LVEF as a standalone predictor and explores new avenues, including AI-based multimodal risk assessment.

SCD Risk Management

Clinical Evidence and Implementation of SCD Risk Management

During this year’s meeting of the NVVC in Papendal, Prof Christian Meyer (Duesseldorf, DE) gave an overview on current approaches to SCD risk management.

SCD in the Netherlands

How Are We Currently Managing Patients at Risk of SCD in the Netherlands After Acute MI?

During this year’s meeting of the NVVC in Papendal, Prof Cornelis Allaart (Amsterdam, NL) gave an overview on current approaches to SCD risk management.

Der nicht-ischämische Fall

Feickert stellte eine 61-jährige Patientin mit stark eingeschränkter LVEF (26%) und postentzündlicher Narbe ohne Koronarerkrankung vor.

Der ischämische Fall

Bormann präsentiert einen 59-jährigen Patienten mit ischämischer Herzinsuffizienz, der nach NSTEMI und verschlechterter EF erfolgreich revaskularisiert und mit Defibrillatorweste (WCD) entlassen wurde.

Herzinsuffizienz und GRMT

Herzinsuffizienz und GRMT – was gibt es Neues?

Duncker betont die Bedeutung einer frühzeitigen Kombination von vier wichtigen Medikamenten bei Herzinsuffizienz, die auf Zieldosen auftitriert werden, um die Mortalität zu senken.

SCD Risk Stratification

SCD Risk Stratification in Newly Diagnosed Heart Failure Patients

Prof David Duncker discusses SCD risk stratification in newly diagnosed heart failure patients.

WCD

Implementation of WCD in Clinical Practice – Medical and Economic Outcomes

Join Dr Luca Santini (G. B. GRASSI Hospital, IT) at EHRA 2024 as they discuss Implementation of WCD in Clinical Practice – Medical and Economic Outcomes.

WCD

Implementation of WCD in Clinical Practice – Medical and Economic Outcomes

Join Prof Przemysław Mitkowski (Poznan University of Medical Sciences, PL) at EHRA 2024 as they discuss Implementation of WCD in Clinical Practice – Medical and Economic Outcomes.

SCD Risk Stratification

SCD Risk Stratification in 2024 – What has Changed With Current GRMT?

Join Dr Ilan Goldenberg (University of Rochester Medical Center, US) at EHRA 2024 as they discuss SCD Risk Stratification in 2024 – What has Changed With Current GRMT?

SCD Risk Stratification

SCD Risk Stratification in 2024 – What has Changed With Current GRMT?

Join Dr Carsten Israel (Bethel-Clinic, DE) at EHRA 2024 as they discuss SCD Risk Stratification in 2024 – What has Changed With Current GRMT?

Managing Patients

Managing Patients at Transient Risk of SCD Early After Acute MI

Join Prof Serge Boveda (Clinique Pasteur Toulouse, FR) at EHRA 2024 as they discuss Managing Patients at Transient Risk of SCD Early After Acute MI.

Managing Patients

Managing Patients at Transient Risk of SCD Early After Acute MI

Join Prof Lucas Boersma (St. Antonius Hospital, NL) at EHRA 2024 as they discuss Managing Patients at Transient Risk of SCD Early After Acute MI.

Early GRMT Up-titration

Early SCD Risk in Newly Diagnosed HFrEF Patients – How to Manage Early GRMT Up-titration and the Role of the WCD?

Join Dr Alexander Breitenstein (University Heart Center, CH) at EHRA 2024 as they discuss Early SCD Risk in Newly Diagnosed HFrEF Patients – How to Manage Early GRMT Up-titration and the Role of the WCD?

NVVC-NVT 2023

NVVC-NVT 2023 – Prevention of Sudden Cardiac Death in Newly Diagnosed Heart Failure Patients and the Role of the Wearable Cardioverter Defibrillator (WCD)

Join Prof Lucas Boersma and Dr Stefan Winter at NVVC-NVT 2023 in this symposium on 'Prevention of Sudden Cardiac Death in Newly Diagnosed Heart Failure Patients and the Role of the Wearable Cardioverter Defibrillator (WCD)'.

Prevention of SCD

The Role of the Wearable Cardioverter Defibrillator in the Prevention of Sudden Cardiac Death

Prof Niels van Royen (Radboud University Medical Center, NL) presents The Role of the Wearable Cardioverter Defibrillator in the Prevention of Sudden Cardiac Death from NVVC Najaarscongres 2022.

Best Practice From Graz

WCD Experiences & Best Practice From Graz

Dr Martin Manninger (Medical University of Graz, AT) presents WCD Experiences & Best Practice From Graz from NVVC Najaarscongres 2022.

Telemedizinischer

Einfluss telemedizinischer Ansätze auf die ambulante Betreuung der Patienten

Professor Christian Perings (Lünen, Deutschland) referiert zum Einfluss telemedizinischer Ansätze auf die ambulante Betreuung der Patienten.

Diagnose von Herzinsuffizienz

Diagnose von Herzinsuffizienz und das Risiko des plötzlichen Herztods (SCD)

Doktor Christian Ebner (Linz, Österreich) spricht über die Diagnose von Herzinsuffizienz und das Risiko des plötzlichen Herztods (SCD).

Herzinsuffizienz

Geschlechterspezifische Unterschiede bei der Herzinsuffizienz

Doktor Anna Rab (Schwarzach, Österreich) thematisiert geschlechterspezifische Unterschiede bei der Herzinsuffizienz.

ESC Guidelines

ESC Guidelines Directed SCD Risk Stratification in Patients With Newly Diagnosed HF

According to Dr José González-Costello (Hospital Universitario de Bellvitge, ES) ESC guideline-directed sudden cardiac death (SCD) risk stratification in patients with newly diagnosed HF is crucial for identifying individuals at high risk of SCD and implementing appropriate preventive strategies.

HF-OPT Study

HF-OPT Study: Prolonged Intensified Medical Treatment to Improve LVEF in Newly Diagnosed HF

Prof Christian Veltmann (Hannover Medical School, Germany) presented first results of the HF OPT Study.

Newly Diagnosed HF

Newly Diagnosed HF and the Role of the Wearable Cardioverter Defibrillator

Dr Luca Santini (G. B. GRASSI Hospital, Italy) focused on the role of the wearable cardioverter defibrillator (WCD) during the high-risk phase in HF-patients.

The BMAD Trial

The BMAD Trial: Impact of Heart Failure Management Using Thoracic Fluid Monitoring From a Novel Wearable Sensor

Dr Marat Fudim (Duke University, US) presented the results of the BMAD Trial. BMAD was conducted with ZOLL HFMS (Heart Failure Management System), the first and only patch-based pulmonary fluid monitor.

Clinical Publications

WCD After Cardiac Surgery

Wearable cardioverter defibrillator after cardiac surgery: analysis of real-life data from patients at transient risk of sudden cardiac death

Elbayomi M, Weyand M, Seitz T, Harig F. Ann Noninvasive Electrocardiol 2023;28:e13048.

Single Clinical Scenarios

Expanded application of wearable cardioverter defibrillators beyond current guidelines: proposal for a European register explained through single clinical scenarios

Buia V, Ciotola F, Bastian D, et al. Open Heart 2024;11:e002597.

Risk Factors for Arrhythmic Death

Risk factors for arrhythmic death, overall mortality, and ventricular tachyarrhythmias requiring shock after myocardial infarction

Lai M, Cheung CC, Olgin J, et al. Am J Cardiol 2023;187:18–25.

Sex Differences and Adherence of Patients

Sex differences and adherence of patients treated with wearable cardioverter-defibrillator: insights from an international multicenter register

Abumayyaleh M, Dreher TC, Rosenkaimer S, et al. J Cardiovasc Electrophysiol 2022;33:2243–9.

WEARIT-II Prospective Registry

Prior history of atrial fibrillation and arrhythmic outcomes: data from the WEARIT-II prospective registry

Goldenberg I, Younis A, McNitt S, et al. J Cardiovasc Electrophysiol 2024;35:785–93.

Heart Failure Risk After MI

Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction

Udell JA, Petrie MC, Jones WS, et al. J Am Coll Cardiol 2024;83:2233–46.

Subcutaneous versus Transvenous

Perioperative safety and early patient and device outcomes among subcutaneous versus transvenous implantable cardioverter defibrillator implantations: a randomized, multicenter trial

Healey JS, Krahn AD, Bashir J, et al. Ann Intern Med 2022;175:1658–65.

Facilitating Shared Decision Making

Facilitating shared decision making among Black patients at risk for sudden cardiac arrest: a randomized clinical trial

Thomas KL, Al-Khatib SM, Kosinski AS, et al. Ann Intern Med 2023;176:615–23.

Implantable Defibrillator System Shock Function

Implantable defibrillator system shock function, mortality, and cause of death after magnetic resonance imaging

Ra J, Oberdier MT, Suzuki M, et al. Ann Intern Med 2023;176:289–97.

REVIVED-BCIS2 trial

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: prespecified analyses from the REVIVED-BCIS2 trial

Perera D, Morgan HP, Ryan M, et al. Circulation 2023;148:862–71.

Late Gadolinium Enhancement in HCM

Assessment of late gadolinium enhancement in hypertrophic cardiomyopathy improves risk stratification based on current guidelines

Wang J, Yang S, Ma X, et al. Eur Heart J 2023;44:4781–92.

Extended Follow-up of the DANISH trial

New York Heart Association functional class and implantable cardioverter-defibrillator in non-ischaemic heart failure with reduced ejection fraction: extended follow-up of the DANISH trial

Karacan MN, Doi SN, Yafasova A, et al. Eur J Heart Fail 2024;26:1423–31.

Data From a Multicentre Registry

Age differences of patients treated with wearable cardioverter defibrillator: data from a multicentre registry

El-Battrawy I, Tenbrink D, Kovacs B, et al. Eur J Clin Invest 2023;53:e13977.

STRONG-HF

Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial

Mebazaa A, Davison B, Chioncel O, et al. Lancet 2022; 400:1938–52.

Heart Failure Optimization Study

Therapy duration and improvement of ventricular function in de novo heart failure: the Heart Failure Optimization study

Veltmann C, Duncker D, Doering M, et al. Eur Heart J 2024; epub ahead of press.

Guidelines

Arrhythmias in Repaired Tetralogy of Fallot

Arrhythmias in repaired tetralogy of Fallot: a scientific statement from the American Heart Association

Krieger EV, Zeppenfeld K, DeWitt ES, et al. Circ Arrhythm Electrophysiol 2022;15:e000084.

The New European Society of Cardiology Guideline

The new European Society of Cardiology guideline for the management of cardiomyopathies: key messages for cardiac electrophysiologists

Korthals D, Eckardt L. Herzschrittmacherther Elektrophysiol 2023;34:311–23.

Syncope in Hypertrophic Cardiomyopathy

Syncope in hypertrophic cardiomyopathy (part II): an expert consensus statement on the diagnosis and management

Brignole M, Cecchi F, Anastasakis A, et al. Int J Cardiol 2023;370:330–7.

2022 ESC Guidelines

What acute cardiac care physicians need to know from the latest 2022 ESC Guidelines for ventricular tachycardia and sudden cardiac death

Goette A, Lip GYH, Gorenek B. Eur Heart J Acute Cardiovasc Care 2023;12:62–8.

NICE Guidelines

Review of the National Institute for Health and Care Excellence guidelines on the management of atrial and ventricular arrhythmias

Lambiase PD, Maclean E. Heart 2024;110:313–22.

ANMCO Position Paper

ANMCO position paper: wearable cardioverter defibrillator appropriate use guidance for the management of patients at high transient risk of sudden cardiac death

Casolo G, Gulizia MM, Aschieri D, et al. G Ital Cardiol (Rome) 2023;24:394–411.

Prolonged QT Interval

The 2023 Canadian Cardiovascular Society clinical practice update on management of the patient with a prolonged QT interval

Davies RA, Ladouceur VB, Green MS, et al. Can J Cardiol 2023;39:1285–301.

10 Novel Key Aspects

Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects

Könemann H, Dagres N, Merino JL, et al. Europace 2023;25:euad091.

Management of Cardiomyopathies

2023 ESC Guidelines for the management of cardiomyopathies

Arbelo E, Protonotarios A, Gimeno JR, et al. Eur Heart J 2023;44:3503–626.

Review Articles

Patient-reported Outcomes

Patient-reported outcomes using a wearable cardioverter-defibrillator: results from a systematic review

Aidelsburger P, Seyed-Ghaemi J, Bonderman D. Int J Technol Assess Health Care 2023;39:e1.

Contemporary Management of Cardiomyopathies

State-of-the-art document on optimal contemporary management of cardiomyopathies

Seferović PM, Polovina M, Rosano G, et al. Eur J Heart Fail 2023;25:1899–922.

Risk of Arrhythmic Death

Risk of arrhythmic death in patients with nonischemic cardiomyopathy: JACC Review topic of the week

Chrispin J, Merchant FM, Lakdawala NK, et al. J Am Coll Cardiol 2023;82:735–47.

Ventricular Arrhythmias

Ventricular arrhythmias in adults with congenital heart disease, part I: JACC State-of-the-Art Review

Bessière F, Waldmann V, Combes N, et al. J Am Coll Cardiol 2023;82:1108–20.

Basic Life Support and Survival

Association between basic life support and survival in sports-related sudden cardiac arrest: a meta-analysis

Michelland L, Murad MH, Bougouin W, et al. Eur Heart J 2023;44:180–92.

Fact or Myth?

Declining risk of sudden cardiac death in heart failure: fact or myth?

Leyva F, Israel CW, Singh J. Circulation 2023;147:759–67.

SCD While Waiting

Sudden cardiac death while waiting: do we need the wearable cardioverter-defibrillator?

Israel C, Staudacher I, Leclercq C, et al. Clin Res Cardiol 2022;111:1189–97.

Radcliffe Content

Immune Cells Associated with Aortic Dissection

Causal Characteristics of Immune Cells Associated with Aortic Dissection: A Mendelian Randomisation Analysis

European Cardiology Review 2025;20:e07.

Extracorporeal Cardiopulmonary Resuscitation

Extracorporeal Cardiopulmonary Resuscitation: Life-saving or Resource Wasting?

US Cardiology Review 2024;18:e12.

New Innovations to Address Sudden Cardiac Arrest

US Cardiology Review 2024;18:e09.

Arrhythmogenic Mitral Valve Prolapse

Arrhythmogenic Mitral Valve Prolapse: Can We Risk Stratify and Prevent Sudden Cardiac Death?

Arrhythmia & Electrophysiology Review 2024;13:e11.

Cardiac Sympathetic Denervation

Cardiac Sympathetic Denervation as a Treatment for Ventricular Arrhythmias Refractory to Conventional Treatment: A Case Series

Interventional Cardiology 2024;19:e06.

Validation of the MIRACLE2 Score

Validation of the MIRACLE2 Score for Prognostication After Out-of-hospital Cardiac Arrest

Interventional Cardiology 2023;18:e29.

Investigating the Cardiac Arrest Survivor

Explaining the Unexplained: A Practical Approach to Investigating the Cardiac Arrest Survivor

Arrhythmia & Electrophysiology Review 2023;12:e27.

Artificial Intelligence

Artificial Intelligence in Ventricular Arrhythmias and Sudden Death

Arrhythmia & Electrophysiology Review 2023;12;e17.

References

References

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4.    McDonagh T, et al. Eur H J 2021;36:3599–726.
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6.    Veltmann C, et al. Eur H J 2024;00:1–11.
7.    Januzzi JL, et al. JAMA 2019;322:1085–95.
8.    Duncker D, et al. Eur H J 2025;00:1–10.