title: Sudden cardiac death in 2017: Spotlight on prediction and prevention.
abstract: This commentary will provide a brief synopsis of the progress made in prediction and prevention of sudden cardiac death (SCD), the challenges that remain, and the opportunities available to make a real impact in this field. The dawning of the new millennium saw the prophylactic implantable defibrillator (ICD) firmly established as the major primary prevention modality, poised to make a major impact on the burden of SCD. More than a decade and a half later, has this expectation been realized? The modest impact of the primary prevention ICD on SCD burden is largely due to the now well-recognized inadequate performance of the left ventricular ejection fraction as a risk stratification tool. Consequently, the field has transitioned from a focus on the "high-risk ejection fraction" to the broader concept of the "high-risk patient". There are currently no effective means of stratifying SCD risk in patients with preserved EF, who constitute the majority (at least 70%) of all patients who will suffer SCD. Can the field be disrupted and novel predictors of SCD identified? In addition to the ongoing quest for identification of the high-risk patient early in the nature history of SCD, a new paradigm for preventing SCD in the "near-term", within several weeks of the lethal event, has been proposed. While rapid advances in technology, data warehousing and analysis will accelerate the process of enhancing SCD prediction and prevention; regulatory, funding and clinical implementation strategies will need to keep pace if these expectations are to be realized.
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States. Electronic address: sumeet.chugh@cshs.org.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D016757:Death, Sudden, Cardiac / Q000473:pathology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology