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<p>Sudden cardiac death (SCD) is still one of the leading causes of cardiovascular mortality, despite substantial progress in modern cardiovascular medicine. While the indications for implantation of an implantable cardioverter defibrillator (ICD) for secondary prevention in survivors of ventricular tachyarrhythmia are based on strong evidence and clear guideline-conform recommendations, the primary prevention is still complex and characterized by substantial uncertainty. Current strategies for primary prevention are predominantly based on the left ventricular ejection fraction, particularly in patients with ischemic cardiomyopathy; however, a&#xa0;substantial proportion of SCD events occur outside established high-risk collectives, whereas many wearers of ICDs do not develop malignant ventricular arrhythmia. This discrepancy reflects the heterogeneity of arrhythmogenic substrates, the temporal dynamics of the individual risk and the influence of competing causes of death. This review article summarizes current guideline-based concepts for primary and secondary prevention of SCD and critically discusses the disease-specific strengths and limitations. A&#xa0;special focus is on cardiomyopathies, hereditary primarily electrical and inflammatory heart diseases, in which conventional risk markers frequently only have limited discriminatory power. Furthermore, new developments in risk stratification are presented, including advanced imaging procedures, genetic markers, artificial intelligence (AI)-assisted models based on raw electrocardiograph (ECG) signals and cardiac magnetic resonance imaging data.</p>

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Primäre und sekundäre Prävention des plötzlichen Herztodes

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Alireza Sepehri Shamloo,
  • Gerhard Hindricks

摘要

Sudden cardiac death (SCD) is still one of the leading causes of cardiovascular mortality, despite substantial progress in modern cardiovascular medicine. While the indications for implantation of an implantable cardioverter defibrillator (ICD) for secondary prevention in survivors of ventricular tachyarrhythmia are based on strong evidence and clear guideline-conform recommendations, the primary prevention is still complex and characterized by substantial uncertainty. Current strategies for primary prevention are predominantly based on the left ventricular ejection fraction, particularly in patients with ischemic cardiomyopathy; however, a substantial proportion of SCD events occur outside established high-risk collectives, whereas many wearers of ICDs do not develop malignant ventricular arrhythmia. This discrepancy reflects the heterogeneity of arrhythmogenic substrates, the temporal dynamics of the individual risk and the influence of competing causes of death. This review article summarizes current guideline-based concepts for primary and secondary prevention of SCD and critically discusses the disease-specific strengths and limitations. A special focus is on cardiomyopathies, hereditary primarily electrical and inflammatory heart diseases, in which conventional risk markers frequently only have limited discriminatory power. Furthermore, new developments in risk stratification are presented, including advanced imaging procedures, genetic markers, artificial intelligence (AI)-assisted models based on raw electrocardiograph (ECG) signals and cardiac magnetic resonance imaging data.