Ventricular Arrhythmia Clinical Practice Guidelines (ESC, 2022)

European Society of Cardiology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

September 30, 2022

Updated clinical guidelines for managing patients with ventricular arrhythmias and preventing sudden cardiac death were published in August 2022 by the European Society of Cardiology (ESC), in the European Heart Journal.[1]

In patients presenting with tolerated sustained monomorphic ventricular tachycardia (SMVT), first-line treatment with direct current cardioversion is recommended if the anesthetic/sedation risk is low.

In all patients with heart failure who have a reduced ejection fraction, optimal medical treatment, including with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, beta blockers, and sodium-glucose cotransporter 2 inhibitors, is indicated.

It is recommended that catheter ablation be used in preference to escalating anti-arrhythmic drug therapy in patients with coronary artery disease who, despite chronic amiodarone therapy, have recurrent, symptomatic sustained monomorphic ventricular tachycardia (SMVT) or implantable cardioverter defibrillator (ICD) shocks for SMVT.

In patients with symptomatic idiopathic ventricular tachycardia (VT)/premature ventricular complexes from the right ventricular outflow tract or the left fascicles, first-line treatment with catheter ablation is recommended.

It is recommended that in patients below age 50 years, those with dilated cardiomyopathy (DCM)/hypokinetic non-dilated cardiomyopathy (HNDCM) and atrioventricular conduction delay or who have a family history of DCM/HNDCM or sudden cardiac death in a first-degree relative undergo genetic testing (including with regard to the LMNA, PLN, RBM20, and FLNC genes).

It is recommended that patients with hypertrophic cardiomyopathy undergo diagnostic work-up with cardiac magnetic resonance imaging with late gadolinium enhancement.

It is recommended that patients with myotonic dystrophy and SMVT or aborted cardiac arrest not caused by bundle branch reentrant (BBR)-VT undergo ICD implantation.

It is recommended that patients with congenital heart disease who present with sustained ventricular arrhythmias be evaluated for residual lesions or new structural abnormalities.

It is recommended that in patients with long QT syndrome (LQTS) who have documented QT interval prolongation, the risk of arrhythmic events be reduced with beta blockers, ideally non-selective beta blockers (nadolol or propranolol).

In patients with LQT3 who have a prolonged QT interval, mexiletine is indicated.

For more information, please go to Sudden Cardiac Death.

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