
Sudden Cardiac Death
Proven Therapy for Patients at Early Risk of Sudden Cardiac Death
The risk of sudden cardiac death (SCD) or life threatening arrhythmias is notably elevated in patients with newly diagnosed heart failure and reduced ejection fraction in the first 90 days after diagnosis.1,2 Clinical trials have shown that the clinical condition of patients often fluctuates during this period.3 Therefore, optimised guideline recommended medical therapy (GRMT) is crucial before considering further long-term therapies such as implantable cardioverter defibrillator (ICD) implantation.4-5 This reflects the outcome of recent clinical trials, that Reverse Remodeling processes take time despite modern drug therapy.6-7
Section Advisor: Prof Christian Perings

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Featured Video
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
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
Videos

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.

Behandelten Themen:
1. Relevanz des Risikos für den plötzlichen Herztod
2. Die kürzlich veröffentlichten ESC-Leitlinien
3. Empfehlungen für die Risikostratifizierung

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

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

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.

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.

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.

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

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

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

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

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.

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.

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?

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

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.

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.

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?

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)'.

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.

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

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

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

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

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.

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

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.

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.
Further Reading and References

Left-ventricular ejection fraction (LVEF) remains the most relevant predictor of SCD risk.1 According to the most recent guidelines from the European Society of Cardiology (ESC), patients with an LVEF ≤ 35% after an acute cardiac event could be considered for a wearable cardioverter defibrillator (WCD; LifeVest® ZOLL CMS) during the drug therapy optimisation phase.4-5,8 This recommendation is consistent with previous guidelines and is supported by extensive evidence, including data from over 20,000 patients from both retrospective and prospective registries, along with findings from large randomised controlled trials, highlighting the clinical effectiveness of the WCD in terminating ventricular tachyarrhythmias.1,7-13 The median WCD daily wearing time in recent studies and registries exceeds 22 hours.9-15
LifeVest WCD serves as a treatment option for patients with transient risk of SCD, offering advanced protection and monitoring during the early post-cardiac event phase while medical therapy is optimised and permanent risk is assessed. Unlike an ICD, LifeVest is worn outside the body rather than implanted in the chest. It is designed to continuously monitor a patient’s heart, detecting certain life-threatening rapid heart rhythms and automatically deliver a treatment shock to restore normal heart rhythm.

1. Olgin JE, et al. N Engl J Med 2018;379:1205–15.
2. Solomon SD, et al. N Engl J Med 2005;352:2581–8.
3. Kutyifa V, et al. Circulation 2015;132:1613–9.
4. McDonagh T, et al. Eur H J 2021;36:3599–726.
5. Zeppenfeld K, et al. Eur H J 2022;43:3997–4126.
6. Veltmann C, et al. Eur H J 2024;00:1–11.
7. Januzzi JL, et al. JAMA 2019;322:1085–95.
8. McDonagh T, et al. Eur H J 2023;37:3627–39.
9. Epstein AE, et al. JACC 2013;62:2000–7.
10. Wäßnig NK, et al. Circulation 2016;134:635–43.
11. Nguyen E, et al. J Innov Card Rhythm Manag 2018;9:3151–62.
12. Mueller-Leisse J, et al. ESC Heart Fail. 2021;8:5142–8.
13. Garcia R, et al. EP Europace 2021;23:73–81.
14. Odeneg T, et al. Eur J of Card Nurs 2019;18:75–83.
15. Kovacs B, et al. Swiss Med Wkly 2020;150:w20343.
Clinical Publications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

European Cardiology Review 2025;20:e07.

US Cardiology Review 2024;18:e12.

US Cardiology Review 2024;18:e09.

Arrhythmia & Electrophysiology Review 2024;13:e11.

Interventional Cardiology 2024;19:e06.

Interventional Cardiology 2023;18:e29.

Arrhythmia & Electrophysiology Review 2023;12:e27.

Arrhythmia & Electrophysiology Review 2023;12;e17.