Sudden Cardiac Death Prevention and ICD Optimization: Risk Stratification, Implantation, and Infection Avoidance

Sudden cardiac death (SCD) remains a leading cause of mortality worldwide, driving ongoing innovation in both prevention and clinical management. Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D) are cornerstone therapies that offer life-saving protection for patients at high risk. However, the effectiveness of these interventions is tempered by key challenges: precision in risk stratification, variable utilization and timing, the choice of device modality, and significant concerns regarding cardiac implantable electronic device (CIED) infections. As device indications broaden and patient populations become older and present with more comorbid conditions, the importance of integrating infection risk with arrhythmic risk in the decision-making pathway is paramount. CIED infection, associated with considerable morbidity, mortality, and healthcare expenditure, mandates rigorous prevention, early detection, and optimal management practices throughout the device therapy continuum.This Research Topic aims to advance the field by promoting an integrated, evidence-based approach to SCD prevention and ICD/CRT-D management, with a special focus on infection avoidance strategies. The main goal is to establish a comprehensive platform for research and discussion that spans innovative risk stratification techniques, judicious device selection, procedural best practices, and robust post-implantation surveillance. Through synergy between clinical research, technological development, implementation science, and system-wide quality improvement, this initiative seeks to shape patient-centered frameworks that improve survival while minimizing the infection risk and procedural complications associated with CIED implantation.As part of a coordinated two-part series on sudden cardiac death, this Research Topic focuses on the clinical management side of SCD prevention — device selection, implantation strategy, and infection avoidance. It complements a companion Research Topic which addresses the mechanistic electrophysiology, predictive modelling, and post-arrest resuscitation foundations of arrhythmic risk. Manuscripts focused primarily on ion-channel mechanisms, novel predictive biomarkers, or resuscitation and post-arrest outcomes should therefore be submitted here Mechanism-informed Prediction and Prevention of Sudden Cardiac Death: Bridging Electrophysiology, Data Science and Critical CareTo gather further insights into this crucial intersection of arrhythmia management and infection prevention, we welcome articles addressing, but not limited to, the following themes:o SCD risk stratification specifically to inform ICD/CRT-D implantation decisions, including imaging biomarkers, genetic and ECG markers, electrophysiological testing, and AI-driven prediction models beyond traditional LVEF assessmento Optimizing indications, timing, and shared decision-making for ICD/CRT-D implantation in diverse populations and across the spectrum of cardiomyopathieso Comparative effectiveness of device strategies: transvenous versus subcutaneous ICDs, leadless or conduction system pacing, wearable defibrillators, and hybrid approacheso Predicting and reducing infection risk, including patient-related comorbidities, procedural complexity, device type, and risks associated with reinterventionso Procedural and peri-procedural prevention bundles: antibiotic prophylaxis, antisepsis protocols, pocket management, use of antimicrobial envelopes, and optimized sterile techniqueso Post-implant monitoring strategies for early infection detection using remote monitoring, inflammatory biomarkers, imaging, and structured clinical pathwayso Diagnostic and therapeutic approaches to CIED infection: extraction, reimplantation considerations, and patient outcomeso System-level, economic, and antimicrobial stewardship interventions to reduce infection burden and improve cost-effectiveness of device therapyThe scope of this Research Topic includes all article types. Ultimately, the aim is to drive progress toward safer, more effective, and patient-tailored SCD prevention, balancing optimal arrhythmic protection with best-in-class infection prevention strategies. Topic editors: Michael Spartalis, Andrea Matteucci Source: https://www.frontiersin.org/research-topics/84648/sudden-cardiac-death-prevention-and-icd-optimization-risk-stratification-implantation-and-infection-avoidance