• epidemiology
• electrocardiography
• cardiac arrhythmias and resuscitation science

Sudden cardiac death (SCD) is a devastating disease affecting roughly 1 in 1000 individuals annually. The majority is dying prematurely before reaching the age of 70 years. SCD thus leads to an immediate loss of life years, often in previously unaffected individuals. And even if SCD is aborted, the common sequelae of cerebral hypoxia result in severe disability and a loss in quality of life. SCD is not a rare phenomenon. The incidence may be highest in specific risk groups including patients suffering from inherited arrhythmia syndromes or patients with severe pre-existing myocardial diseases. Yet, the by far most affected cohort is the general population. The general population incidence of SCD may be small, but the large denominator of individuals at risk results in the highest number of SCD cases overall.1 2

To reduce the burden of SCD, effective risk prediction is warranted. Given the large number of SCD cases in the general population, here effective prevention would yield the largest benefit. Yet, lacking specific prediction tools and balancing the large number of individuals to screen, no easily applicable solution is at hand. Several prediction models were proposed, which exemplarily include the ECG-derived measure of global electric heterogeneity,3 or a combination of demographic, clinical and biomarker characteristics.4 Despite convincing statistical results, neither model entered broader clinical application or resulted in actionable preventive treatment. Thus, for preventing SCD in the community, all present guidelines rely on the benchmark of left ventricular dysfunction. Primary prevention includes optimal drug therapy in case of heart failure …