Artificial intelligence in ventricular arrhythmias and sudden cardiac death: A guide for clinicians

Sudden cardiac death (SCD) from ventricular arrhythmias (VAs) remains a leading cause of mortality worldwide. Traditional risk stratification, primarily based on left ventricular ejection fraction (LVEF) and other coarse metrics, often fails to identify a large subset of patients at risk and frequently leads to unnecessary device implantations. Advances in artificial intelligence (AI) offer new strategies to improve both long-term SCD risk prediction and near-term VAs forecasting. In this review, we discuss how AI algorithms applied to the 12-lead electrocardiogram (ECG) can identify subtle risk markers in conditions such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and coronary artery disease (CAD), often outperforming conventional risk models. We also explore the integration of AI with cardiac imaging, such as scar quantification on cardiac magnetic resonance (CMR) and fibrosis mapping, to enhance the identification of the arrhythmogenic substrate. Furthermore, we investigate the application of data from implantable cardioverter-defibrillators (ICDs) and wearable devices to predict ventricular tachycardia (VT) or ventricular fibrillation (VF) events before they occur, thereby advancing care toward real-time prevention. Amid these innovations, we address the medicolegal and ethical implications of AI-driven automated alerts in arrhythmia care, highlighting when clinicians can trust AI predictions. Future directions include multimodal AI fusion to personalize SCD risk assessment, as well as AI-guided VT ablation planning through imaging-based digital heart models. This review provides a comprehensive overview for general medical readers, focusing on peer-reviewed advances globally in the emerging intersection of AI, VAs, and SCD prevention.