In this episode of Arrhythmia Academy's Journal Club, Dr David Duncker (Hannover Heart Rhythm Center, DE) is joined by Dr Marat Fudim (Duke University, US) to examine the critical early-risk period following heart failure diagnosis and the emerging role of wearable cardioverter defibrillators in sudden cardiac death prevention.

The discussion centres on findings from the SCD-PROTECT study, a 19,000-patient German registry representing the world's largest experience with wearable cardioverter defibrillators. Dr Fudim presents compelling evidence of extreme early vulnerability, with one-third of shockable events occurring within the first 10 days of hospital discharge, a risk period that precedes the protective benefits of guideline-directed medical therapy.

Dr Fudim addresses the gap between current guideline recommendations and clinical evidence, advocating for updated protocols that acknowledge this vulnerable phase and emphasising the importance of transparent patient communication regarding sudden death risk. The episode concludes with practical considerations for implementing wearable cardioverter defibrillators as a bridge therapy while GDMT takes effect.

Recorded remotely from Hannover and Durham, 2026.