Sudden cardiac death (SCD) remains a pressing health issue, affecting hundreds of thousands each year globally. The heterogeneity among SCD victims, ranging from individuals with severe heart failure to seemingly healthy individuals, poses a significant challenge for effective risk assessment. Conventional risk stratification, which primarily relies on left ventricular ejection fraction, has resulted in only modest efficacy of implantable cardioverter-defibrillators (ICD) for SCD prevention. In response, artificial intelligence (AI) holds promise for personalised SCD risk prediction and tailoring preventive strategies to the unique profiles of individual patients. Machine and deep learning algorithms have the capability to learn intricate non-linear patterns between complex data and defined endpoints, and leverage these to identify subtle indicators and predictors of SCD that may not be apparent through traditional statistical analysis. However, despite the potential of AI to improve SCD risk stratification, there are important limitations that need to be addressed. We aim to provide an overview of the current state-of-the-art of AI prediction models for SCD, highlight the opportunities for these models in clinical practice, and identify the key challenges hindering widespread adoption.

BACKGROUND: Normally-functioning implantable cardioverter-defibrillators (ICDs) with intact lead systems occasionally fail to deliver therapy for ventricular tachycardia/ fibrillation (VT/VF) or deliver it only after clinically-significant delays (\"failure-to-treat\").
OBJECTIVE: To investigate ICD failure-to-treat VT/VF in a large patient cohort.
METHODS: We searched the United States (US) Food and Drug Association\'s online Manufacturer and User Facility Device Experience (MAUDE) database from 2019 to 2023 for manufacturer-verified reports in which normally-functioning ICDs failed to treat VT/VF.
RESULTS: We identified 854 reports classified as deaths (n=96, 11.2%), injuries (n=585, 68.5%), or malfunctions (n=173, 20.4%) for normally-functioning ICDs. The most common causes were misclassification as supraventricular tachycardia (SVT) or atrial fibrillation (AF) (54.8%), undersensing (21.1%), and failure to satisfy programmed rate/duration criteria (8.7%). Most events caused by misclassification as SVT/AF (89.5%) and failure to satisfy rate/duration criteria (70.3%) were VT; most caused by undersensing were either VF (54.4%) or not specified as VT or VF (19.4%). Undersensing caused 65.6% of deaths, although it comprised only 21.1% of reports. In the United States, the number of reports increased faster than that of ICD patients.
CONCLUSIONS: In the largest reported series of failure-to-treat VT/VF by normally-functioning ICDs, the most common cause was misclassification of VT as SVT/AF; the most common cause of death was undersensing of VF. Although relatively few patients with normally-functioning ICDs experience failure-to-treat VT/VF, the absolute number of verified MAUDE reports suggests that more work is needed to quantify the magnitude of the problem, identify root causes, and develop solutions.

BACKGROUND: Post-myocardial infarction (MI) patients with ventricular tachycardia (VT) are considered at risk for VT recurrence and sudden cardiac death (SCD). Recent guidelines indicate that in selected patients catheter ablation should be considered instead of an implantable cardioverter-defibrillator (ICD).
OBJECTIVE: This study aimed to analyze outcomes of patients referred for VT ablation according to left ventricular ejection fraction (LVEF), tolerance of VT, and acute ablation outcome.
METHODS: Post-MI patients without prior ICD undergoing VT ablation at a single center between 2009 and 2022 were included. Patients who presented with tolerated VT and who had an LVEF >35% were offered catheter ablation as first-line therapy. ICD implantation was offered to all patients but was subject to shared decision according to clinical presentation, LVEF, and ablation outcome.
RESULTS: Eighty-six patients (mean age 69 ± 9 years, 84% male, mean LVEF 41 ± 9%) underwent VT ablation. In 66 patients, LVEF was >35%, of whom 51 had tolerated VT. Of these 51 patients, 37 (73%) were rendered noninducible. In 5 of 37 noninducible and in 11 of 14 inducible patients, an ICD was implanted. During a median follow-up of 40 months (Q1-Q3: 24-70 months), 10 of 86 patients had VT recurrence. The overall mortality was 27%, and 1 patient with ICD died suddenly. Among the 37 patients (none on antiarrhythmic drugs) with LVEF >35%, tolerated VT, and noninducibility, no SCD or VT recurrence occurred. Among the 14 patients with LVEF >35%, tolerated VT, and inducibility after ablation, no SCD occurred, but VT recurred in 29%.
CONCLUSIONS: Post-MI patients with LVEF >35%, tolerated VT, and noninducibility after ablation have an excellent prognosis. Deferring ICD implantation seems to be safe in these patients.

Blood culture-negative endocarditis (BCNE) poses significant diagnostic and therapeutic challenges and is associated with notable morbidity and mortality. When presented concurrently with other comorbidities, these challenges and the chances of morbidity and mortality significantly increase. This case presents right-sided BCNE accompanied by pulmonary cavitary lesions in a patient with a history of supraventricular tachycardias (SVT), a biventricular pacemaker and implantable cardioverter-defibrillator (BiV-ICD), alcohol use, and anticoagulant noncompliance. The patient missed follow-up appointments for six months after the death of his wife, leading to increased alcohol use and noncompliance with medications. During this period, his home monitoring device was offline. Once reconnected, it detected several episodes of SVT and ventricular tachycardia (VT), prompting a wellness check. He presented to the cardiology clinic with shortness of breath and a cough producing brown-tinged sputum. Evaluation revealed cavitary lesions in the lingula and left lower lobe, a vegetation on his tricuspid valve, and vegetations on his endocardial leads, despite negative blood cultures. Tuberculosis testing was negative, while sputum cultures were positive for Haemophilus influenzae. After ruling out other possible infectious causes of the cavitary lesions, septic emboli were suspected as the cause. Broad-spectrum antibiotics were begun and surgical intervention was done to replace the tricuspid valve and remove the endocardial leads. This procedure was complicated by fibrosis of the leads at the coronary sinus, necessitating their cutting at the superior vena cava and leaving them inside the patient until laser therapy could be performed for their removal. The patient\'s history of bradycardia and SVTs required the ongoing use of a pacemaker. Inventory discrepancy during the placement of the new pacemaker epicardial leads lead to complications warranting an alternative approach to lead implantation. A traditionally used epicardial lead was placed on the right ventricle for pacing, and an innovative technique was employed to place an endocardial lead on the right atrium epicardium for sensing. This case underscores the importance of thorough evaluation and collaborative management strategies to optimize outcomes for patients with concomitant cardiac and pulmonary pathologies, particularly in the context of underlying psychosocial stressors. Additionally, it demonstrates solutions to challenges that can arise during surgery and presents an alternative lead placement technique for physicians who have only one epicardial lead available after removing infected endocardial leads. This is illustrated by the innovative use of an endocardial lead as an epicardial sensing lead.

As an alternative to transvenous ICD systems, two non-transvenous ICD systems have been established in recent years: The subcutaneous ICD (S-ICD), which has been established for several years, has a presternal electrode that is implanted subcutaneously and offers a shock function and, to a limited extent, post-shock pacing. In addition, the extravascular ICD (EV-ICD) has been available in Europe since 2023 which does not require transvenous electrodes and offers the option of providing patients with antibradycardic and antitachycardic stimulation in combination with a conventional ICD function. The lead of this device is implanted substernally. Initial implantation results are promising in terms of safety and effectiveness. Both systems avoid possible complications of transvenous electrodes. This article provides practical guidance for the implantation technique and possible complications.
UNASSIGNED: Als Alternative zu transvenösen ICD-Systemen sind aktuell zwei nichttransvenöse ICD-Systeme verfügbar: Der seit einigen Jahren etablierte subkutane ICD (S-ICD) verfügt über eine prästernale Elektrode, die subkutan implantiert wird und die eine Schockfunktion sowie in begrenztem Umfang auch eine Post-Schock-Stimulation bietet. Außerdem ist in Europa seit 2023 der extravaskuläre ICD (EV-ICD) erhältlich, welcher ebenfalls ohne transvenöse Elektroden auskommt und die Möglichkeit bietet, Patienten mit einer antibradykarden und antitachykarden Stimulation in Kombination mit einer herkömmlichen ICD-Funktion zu versorgen. Bei diesem Device erfolgt die Elektrodenimplantation substernal. Erste Implantationsergebnisse sind im Hinblick auf Sicherheit und Effektivität vielversprechend. Beide Systeme umgehen einige mögliche Komplikationen transvenöser Elektroden. Dieser Artikel soll eine praktische Übersicht der Implantationsschritte und möglicher Komplikationen geben.

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UNASSIGNED: There is an increase in the sale of legal drugs in our country. One of these substances is kratom. Kratom (Mitragyna speciosa) is a partial agonist of the opioid kappa, mu, and delta receptors. It acts as a stimulant at low concentrations, making users feel more energetic and euphoric. It has sedative and antinociceptive effects at higher doses.
UNASSIGNED: An 18-year-old man collapsed during football training and required cardiopulmonary resuscitation; the initial rhythm was ventricular fibrillation managed by defibrillation. Laboratory parameters were unremarkable. Blood samples sent for toxicological evaluation were positive for kratom and caffeine. Echocardiographic examination, coronary computed tomography angiography, and cardiac magnetic resonance imaging did not prove the cause. Genetic testing did not find a pathogenic gene variant associated with familial ventricular fibrillation, but a variant of unknown significance was found in MYOM1. Given this situation, we implanted an implantable cardioverter-defibrillator (ICD) from the secondary prevention of sudden cardiac death (SCD) according to the guidelines of the European Society of Cardiology (ESC). No recurrence of ventricular arrhythmia has been reported by ambulatory ICD memory checks on our patient.
UNASSIGNED: In some country, kratom is freely available and sold as a plant, not a drug. Only incident cases of ventricular fibrillation after kratom use are described in the literature. There is insufficient scientific evidence linking kratom to ventricular fibrillation. This is an absolutely crucial case report of this type, which has not yet been published in similar circumstances in the world. Therefore, the development of ventricular fibrillation was assumed to be due to a combination of kratom, caffeine, and exercise. The safety profile and effects of kratom should be the subject of future research. We would like to stress the importance of reporting further case series for more scientific evidence and thus increasing the pressure for stricter availability and regulation of kratom in some countries, especially where it is over-the-counter.

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