Transient versus Persistent Risk of Sudden Cardiac Death: Implications for Wearable Defibrillator Use: Powered by Zoll-Zoll Collaborative Executive Summary

Zoll Collaborative Executive Summary

Pdf Summary

Sudden cardiac death (SCD) remains a leading cause of mortality among patients with heart failure, recent myocardial infarction (MI), and newly diagnosed cardiomyopathies. While implantable cardioverter-defibrillators (ICDs) effectively reduce long-term SCD risk in selected patients, some patients face transient or reversible risk periods during which immediate ICD implantation may be inappropriate, especially when left ventricular ejection fraction (LVEF) could improve with optimized therapy. Despite advances in guideline-directed medical therapy (GDMT), a vulnerable "window" exists during therapy optimization when patients remain at high risk and unprotected. The recent SCD-PROTECT study of nearly 20,000 wearable cardioverter-defibrillator (WCD) users highlights ongoing SCD risk in post-MI and newly diagnosed non-ischemic cardiomyopathy patients initiating GDMT.<br /><br />The WCD offers a non-invasive, temporary solution to this issue by providing continuous monitoring and timely defibrillation during high-risk periods. This device allows time for optimizing GDMT, promoting cardiac function recovery, and reassessing long-term SCD risk before committing to permanent ICD implantation. To reduce SCD risk effectively during these vulnerable intervals, a comprehensive approach is essential: accelerating GDMT optimization via structured protocols; early evaluation of patients with systolic dysfunction for WCD candidacy; embedding SCD risk assessment within heart failure, MI, and cardiomyopathy care pathways; and enhancing clinician and patient education through targeted training and support programs.<br /><br />By integrating WCD use into clinical workflows and ensuring rapid initiation of evidence-based therapy, healthcare systems can better protect patients from SCD during transient risk periods. This patient-centered, multifaceted strategy aligns with the evolving landscape of heart failure and cardiomyopathy care, aiming to reduce SCD incidence and improve outcomes.

Keywords

Sudden Cardiac Death

Heart Failure

Myocardial Infarction

Cardiomyopathy

Implantable Cardioverter-Defibrillator

Wearable Cardioverter-Defibrillator

Left Ventricular Ejection Fraction

Guideline-Directed Medical Therapy

SCD-PROTECT Study

Risk Assessment