Sudden Cardiac Death (SCD) is one of the leading causes of death world wide. It is caused by ventricular arrhythmias and usually occurs suddenly without much notice. SCD can occur in patients with structural abnormal hearts specifically the patient with left sided systolic heart failure. The ejection fraction associated with risk of SCD is less than or equal to 35%. It can also occur in patients with structurally normal hearts but with pre-existing channelopathies or other arrhythmia substrates. The treatment is aimed at reducing the chances of having a ventricular event by treating the underlying substrate, reversing any conditions if possible, Guideline Directed Medical Therapy (GDMT) along with defibrillator implant. Implantable Cardiac Defibrillators (ICD) prevent SCD in the right patient population. Clinical trials have demonstrated benefit of GDMT along with ICD implant in prevention of SCD. The correct patient and timing needs to be identified for ICD implant. Also genetic testing for family members is vital for patient with inherited disease to be able to risk stratify their relatives. Patients with end stage conditions need to be identified as those patents will not benefit from an invasive procedure of the ICD implant and should be treated conservatively medically. Reversible causes of increased risk of SCD need to be identified early and treated appropriately to decrease the risk of SCD and those conditions will not require ICD implant. In this presentation, we will go over the risk factors associated with SCD and what steps need to be taken to decrease the risk and prevent SCD. We will also go over the guidelines (USA) regarding ICD implant along with conditions when an ICD should not be implanted. We will go over some of the reversible causes which can be successfully reversed and hence reduce the risk and avoid a device implant.