2022 ESC Clinical Practice Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

The first of these guidelines, the 2022 ESC Guidelines for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD),¹ was unveiled yesterday by Professor Katja Zeppenfeld (Leiden University Medical Centre - Leiden, Netherlands) and Professor Jacob Tfelt-Hansen (Copenhagen University Hospital - Copenhagen, Denmark), Chairs of the Guidelines Task Force.

“Since the previous version in 2015, there have been new insights into the epidemiology of SCD, additional evidence on genetics, imaging and clinical findings for risk stratification for VA and SCD, and advances in diagnostic evaluation and therapeutic strategies, all of which prompted the new update,” says Prof. Zeppenfeld.

Survival rate remains low after out-of-hospital cardiac arrest (OHCA) and new recommendations are given for public basic life support and for access to automated external defibrillators (AED). “The public is our major ally in the battle against SCD in communities,” says Prof. Tfelt-Hansen, “And everyone, including schoolchildren, should learn how to do cardiopulmonary resuscitation (CPR) and use an AED. Both of these actions can save lives.” It is now recommended that public access defibrillation be available at sites where cardiac arrest is more likely to occur, such as shopping malls, stadiums, public transport stations and casinos. Promoting community training in basic life support is recommended to increase bystander CPR rate and AED use. Furthermore, mobile phone-based alerting of basic life support-trained bystander volunteers to assist nearby OHCA victims should be considered. 

There are new sections on diagnostic evaluation, including pharmacologic provocative tests, genetic testing and a systematic work-up of probands and relatives with primary electrical diseases. Comprehensive flowcharts and recommendations are provided for the diagnostic evaluation at first presentation with a VA of patients without a previously known cardiac disease for five frequently encountered clinical scenarios, including the incidental finding of a non-sustained ventricular tachycardia, first presentation of sustained monomorphic ventricular tachycardia and sudden cardiac arrest survivors. Links are provided throughout the document to ESC CardioMed chapters for additional content. 

An electrical storm is common in patients with an implantable cardioverter defibrillator (ICD) and a new section deals with the management of patients with electrical storm or recurrent ICD discharges. Regarding long-term management and device therapy, special aspects are considered, with a recommendation for optimisation of device programming to avoid inappropriate and unnecessary therapies and reduce mortality.

The second part of the guidelines is structured according to disease-specific management. Risk stratification, SCD prevention, treatment of VA and management of family members are addressed in a systematic fashion. Indications for cardiac magnetic resonance, genetic testing and updated indications for catheter ablation are presented. Flowcharts summarise the workflow for diagnosis and treatment for each disease entity.

Want to know more about what’s new? The 2022 ESC Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD are now published in the European Heart Journal!