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

Zoll Collaborative Insights Report

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This article reviews the transient versus persistent risk of sudden cardiac death (SCD) and the role of wearable cardioverter defibrillators (WCDs) in managing patients with reversible or uncertain arrhythmic risk. SCD, primarily caused by ventricular arrhythmias, often occurs out-of-hospital and poses a significant global health challenge, with over 300,000 annual cases in the U.S. alone. Risk stratification is dynamic; certain clinical scenarios—such as acute myocardial infarction (AMI), newly diagnosed heart failure (HF), myocarditis, peripartum and chemotherapy-induced cardiomyopathies, and after device explantation—present transient periods of high SCD risk where immediate implantable cardioverter defibrillator (ICD) implantation may not be appropriate.<br /><br />Guidelines advise waiting periods (e.g., 40 days post-AMI, 3-6 months for HF therapy optimization) before ICD implantation, yet peak SCD risk often occurs early post-event, creating a preventive gap. WCDs offer noninvasive, temporary protection during this vulnerable phase, serving as a bridge to either recovery or ICD evaluation. Data from registries and studies including the VEST trial indicate that WCDs can deliver life-saving shocks during transient risk periods, though patient adherence and wear time are critical for effectiveness.<br /><br />Current heart failure therapies (beta-blockers, ARNI, mineralocorticoid receptor antagonists) reduce SCD risk but do not eliminate it, especially during optimization phases. Emerging treatments like SGLT2 inhibitors show promise but require further study. Guidelines from AHA/ACC/HRS recommend WCD use as a Class IIa/IIb indication in selected patients with transient risk.<br /><br />Challenges remain in optimizing patient selection, timing of ICD implantation, and integrating WCD use within clinical workflows. The authors advocate for multidisciplinary education, incorporation of SCD risk assessments into inpatient pathways, and electronic health record triggers to streamline timely identification and referral for WCD use. They emphasize an integrated, evidence-based approach to maximize the benefits of WCDs, minimize morbidity and mortality, and avoid unnecessary permanent device implantation while evaluating long-term SCD risk.

Keywords

sudden cardiac death

wearable cardioverter defibrillators

transient risk

persistent risk

ventricular arrhythmias

implantable cardioverter defibrillator

heart failure

acute myocardial infarction

risk stratification

VEST trial