2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

HomeCirculationVol. 138, No. 132017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUB2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac DeathA Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society Sana M. Al-Khatib, MD, MHS, FACC, FAHA, FHRS, William G. Stevenson, MD, FACC, FAHA, FHRS, Michael J. Ackerman, MD, PhD, William J. Bryant, JD, LLM, David J. Callans, MD, FACC, FHRS, Anne B. Curtis, MD, FACC, FAHA, FHRS, Barbara J. Deal, MD, FACC, FAHA, Timm Dickfeld, MD, PhD, FHRS, Michael E. Field, MD, FACC, FAHA, FHRS, Gregg C. Fonarow, MD, FACC, FAHA, FHFSA, Anne M. Gillis, MD, FHRS, Christopher B. Granger, MD, FACC, FAHA, Stephen C. Hammill, MD, FACC, FHRS, Mark A. Hlatky, MD, FACC, FAHA, José A. Joglar, MD, FACC, FAHA, FHRS, G. Neal Kay, MD, Daniel D. Matlock, MD, MPH, Robert J. Myerburg, MD, FACC and Richard L. Page, MD, FACC, FAHA, FHRS Sana M. Al-KhatibSana M. Al-Khatib Search for more papers by this author , William G. StevensonWilliam G. Stevenson Search for more papers by this author , Michael J. AckermanMichael J. Ackerman Search for more papers by this author , William J. BryantWilliam J. Bryant Search for more papers by this author , David J. CallansDavid J. Callans Search for more papers by this author , Anne B. CurtisAnne B. Curtis Search for more papers by this author , Barbara J. DealBarbara J. Deal Search for more papers by this author , Timm DickfeldTimm Dickfeld Search for more papers by this author , Michael E. FieldMichael E. Field Search for more papers by this author , Gregg C. FonarowGregg C. Fonarow Search for more papers by this author , Anne M. GillisAnne M. Gillis Search for more papers by this author , Christopher B. GrangerChristopher B. Granger Search for more papers by this author , Stephen C. HammillStephen C. Hammill Search for more papers by this author , Mark A. HlatkyMark A. Hlatky Search for more papers by this author , José A. JoglarJosé A. Joglar Search for more papers by this author , G. Neal KayG. Neal Kay Search for more papers by this author , Daniel D. MatlockDaniel D. Matlock Search for more papers by this author , Robert J. MyerburgRobert J. Myerburg Search for more papers by this author and Richard L. PageRichard L. Page Search for more papers by this author Originally published1 Aug 2018https://doi.org/10.1161/CIR.0000000000000549Circulation. 2018;138:e272–e391is corrected byCorrection to: 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm SocietyOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 1, 2018: Ahead of Print Table of ContentsPreamble e2741. Introduction e2751.1. Methodology and Evidence Review e2751.2. Organization of the Writing Committee e2761.3. Document Review and Approval e2761.4. Scope of the Guideline e2771.5. Abbreviations e2792. Epidemiology e2792.1. General Concepts e2792.1.1. Premature Ventricular Complexes and Nonsustained VT e2792.1.2. VT and VF During ACS e2812.1.3. Sustained VT and VF Not Associated With ACS e2812.2. Sudden Cardiac Death e2812.2.1. Incidence of SCD e2812.2.2. Population Subgroups and Risk Prediction e2823. Mechanisms of VA e2833.1. Cellular Mechanisms and Substrates e2833.2. Automaticity e2833.3. Triggered Activity e2833.4. Reentry e2844. General Evaluation of Patients With Documented or Suspected VA e2844.1. History and Physical Examination e2844.2. Noninvasive Evaluation e2864.2.1. 12-lead ECG and Exercise Testing e2864.2.2. Ambulatory Electrocardiography e2864.2.3. Implanted Cardiac Monitors e2874.2.4. Noninvasive Cardiac Imaging e2874.2.5. Biomarkers e2884.2.6. Genetic Considerations in Arrhythmia Syndromes e2884.3. Invasive Testing e2894.3.1. Invasive Cardiac Imaging: Cardiac Catheterization or CT Angiography e2894.3.2. Electrophysiological Study for VA e2895. Therapies for Treatment or Prevention of VA e2905.1. Medication Therapy e2905.1.1. Medications With Prominent Sodium Channel Blockade e2905.1.2. Beta Blockers e2935.1.3. Amiodarone and Sotalol e2935.1.4. Calcium Channel Blockers e2945.1.5. Nonantiarrhythmic Medications and Therapies e2945.2. Preventing SCD With HF Medications e2955.3. Defibrillators for Treatment of VA and SCD e2955.4. Catheter Ablation e2955.4.1. General Considerations e2955.4.2. VA in Patients With No Apparent Structural Heart Disease e2965.4.3. Scar-Related VT e2965.5. Surgery and Revascularization Procedures in Patients With Ischemic Heart Disease e2965.5.1. Surgery for Arrhythmia Management e2975.6. Autonomic Modulation e2976. Acute Management of Specific VA e2977. Ongoing Management of VA and SCD Risk Related to Specific Disease States e3017.1. Ischemic Heart Disease e3017.1.1. Secondary Prevention of SCD in Patients With Ischemic Heart Disease e3017.1.2. Primary Prevention of SCD in Patients With Ischemic Heart Disease e3047.1.3. Treatment and Prevention of Recurrent VA in Patients With Ischemic Heart Disease e3067.2. Nonischemic Cardiomyopathy e3087.2.1. Secondary Prevention of SCD in Patients With NICM e3087.2.2. Primary Prevention of SCD in Patients With NICM e3097.2.3. Treatment of Recurrent VA in Patients With NICM e3107.3. Arrhythmogenic Right Ventricular Cardiomyopathy e3127.4. Hypertrophic Cardiomyopathy e3157.5. Myocarditis e3187.6. Cardiac Sarcoidosis e3187.6.1. Other Infiltrative Cardiomyopathies e3207.7. Heart Failure e3217.7.1. HF With Reduced Ejection Fraction e3217.7.2. HF With Preserved Ejection Fraction e3217.7.3. Left Ventricular Assist Device e3227.7.4. ICD Use After Heart Transplantation e3227.8. Neuromuscular Disorders e3227.9. Cardiac Channelopathies e3247.9.1. Specific Cardiac Channelopathy Syndromes e3258. VA in the Structurally Normal Heart e3348.1. Outflow Tract and Atrioventricular Annular VA e3358.2. Papillary Muscle VA e3358.3. Interfascicular Reentrant VT (Belhassen Tachycardia) e3358.4. Idiopathic Polymorphic VT/VF e3369. PVC-Induced Cardiomyopathy e33710. VA and SCD Related to Specific Populations e33810.1. Athletes e33810.2. Pregnancy e33810.3. Older Patients With Comorbidities e33910.4. Chronic Kidney Disease e34010.5. Valvular Heart Disease e34010.6. Sex-Related Differences in the Risk of SCD e34010.7. Medication-Induced Arrhythmias e34110.8. Adult Congenital Heart Disease e34211. Defibrillators Other than Transvenous ICDs e34711.1. Subcutaneous Implantable Cardioverter-Defibrillator e34711.2. Wearable Cardioverter-Defibrillator e34811.3. Automated External Defibrillator e34912. Special Considerations for Catheter Ablation e34913. Postmortem Evaluation of SCD e35014. Terminal Care e35115. Shared Decision-Making e35116. Cost and Value Considerations e35217. Quality of Life e35318. Evidence Gaps and Future Research Needs e354Appendix 1: Author Relationships With Industry and Other Entities (Relevant) e387Appendix 2: Reviewer Relationships With Industry and Other Entities (Comprehensive) e389PreambleSince 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a cornerstone for quality cardiovascular care. The ACC and AHA sponsor the development and publication of guidelines without commercial support, and members of each organization volunteer their time to the writing and review efforts. Guidelines are official policy of the ACC and AHA.Intended UsePractice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease. The focus is on medical practice in the United States, but guidelines developed in collaboration with other organizations may have a global impact. Although guidelines may be used to inform regulatory or payer decisions, their intent is to improve patients’ quality of care and align with patients’ interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances and should not replace clinical judgment.Clinical ImplementationGuideline-recommended management is effective only when followed by healthcare providers and patients. Adherence to recommendations can be enhanced by shared decision-making between healthcare providers and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities.Methodology and ModernizationThe ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) continuously reviews, updates, and modifies guideline methodology on the basis of published standards from organizations including the Institute of MedicineP-1,P-2 and on the basis of internal reevaluation. Similarly, the presentation and delivery of guidelines are reevaluated and modified on the basis of evolving technologies and other factors to facilitate optimal dissemination of information at the point of care to healthcare professionals.Toward this goal, this guideline heralds the introduction of an evolved format of presenting guideline recommendations and associated text called the “modular knowledge chunk format.” Each modular “chunk” includes a table of related recommendations, a brief synopsis, recommendation-specific supportive text and, when appropriate, flow diagrams or additional tables. References are provided within the modular chunk itself to facilitate quick review. This format also will facilitate seamless updating of guidelines with focused updates as new evidence is published, and content tagging for rapid electronic retrieval of related recommendations on a topic of interest. This evolved format was instituted when this guideline was near completion; therefore, the current document represents a transitional formatting that best suits the text as written. Future guidelines will fully implement this format, including provisions for limiting the amount of text in a guideline.Recognizing the importance of cost–value considerations in certain guidelines, when appropriate and feasible, an analysis of the value of a medication, device, or intervention may be performed in accordance with the ACC/AHA methodology.P-3To ensure that guideline recommendations remain current, new data are reviewed on an ongoing basis, with full guideline revisions commissioned in approximately 6-year cycles. Publication of new, potentially practice-changing study results that are relevant to an existing or new medication, device, or management strategy will prompt evaluation by the Task Force, in consultation with the relevant guideline writing committee, to determine whether a focused update should be commissioned. For additional information and policies regarding guideline development, we encourage readers to consult the ACC/AHA guideline methodology manualP-4 and other methodology articles.P-5–P-8Selection of Writing Committee MembersThe Task Force strives to avoid bias by selecting experts from a broad array of backgrounds. Writing committee members represent different geographic regions, sexes, ethnicities, races, intellectual perspectives/biases, and scopes of clinical practice. The Task Force may also invite organizations and professional societies with related interests and expertise to participate as partners, collaborators, or endorsers.Relationships With Industry and Other EntitiesThe ACC and AHA have rigorous policies and methods to ensure that guidelines are developed without bias or improper influence. The complete relationships with industry and other entities (RWI) policy can be found online. Appendix 1 of the current document lists writing committee members’ relevant RWI. For the purposes of full transparency, writing committee members’ comprehensive disclosure information is available online, as is the comprehensive disclosure information for the Task Force.Evidence Review and Evidence Review CommitteesWhen developing recommendations, the writing committee uses evidence-based methodologies that are based on all available data.P-4–P-7 Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only key references are cited.An independent evidence review committee (ERC) is commissioned when there are ≥1 questions deemed of utmost clinical importance that merit formal systematic review. This systematic review will strive to determine which patients are most likely to benefit from a test, medication, device, or treatment strategy and to what degree. Criteria for commissioning an ERC and formal systematic review include: a) the absence of a current authoritative systematic review; b) the feasibility of defining the benefit and risk in a time frame consistent with the writing of a guideline; c) the relevance to a substantial number of patients; and d) the likelihood that the findings can be translated into actionable recommendations. ERC members may include methodologists, epidemiologists, healthcare providers, and biostatisticians. When a formal systematic review has been commissioned, the recommendations developed by the writing committee on the basis of the systematic review are marked with“SR.”Guideline-Directed Management and TherapyThe term guideline-directed management and therapy (GDMT) encompasses clinical evaluation, diagnostic testing, and pharmacological and procedural treatments. For these and all recommended medication treatment regimens, the reader should confirm the dosage by reviewing product insert material and evaluate the treatment regimen for contraindications and interactions. The recommendations are limited to medications, devices, and treatments approved for clinical use in the United States.Class of Recommendation and Level of EvidenceThe Class of Recommendation (COR) indicates the strength of the recommendation, encompassing the estimated magnitude and certainty of benefit in proportion to risk. The Level of Evidence (LOE) rates the quality of scientific evidence that supports the intervention on the basis of the type, quantity, and consistency of data from clinical trials and other sources (Table 1).P-4,P-6,P-8Table 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015)Glenn N. Levine, MD, FACC, FAHAChair, ACC/AHA Task Force on Clinical Practice Guidelines1. Introduction1.1. Methodology and Evidence ReviewThe recommendations listed in this clinical practice guideline are, whenever possible, evidence-based. An initial extensive evidence review, which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline, was conducted from April 2016 to September 2016. Key search words included, but were not limited, to the following: sudden cardiac death, ventricular tachycardia, ventricular fibrillation, premature ventricular contractions, implantable cardioverter-defibrillator, subcutaneous implantable cardioverter-defibrillator, wearable cardioverter-defibrillator, and catheter ablation. Additional relevant studies published through March 2017, during the guideline writing process, were also considered by the writing committee, and added to the evidence tables when appropriate. The final evidence tables are included in the Online Data Supplement and summarize the evidence used by the writing committee to formulate recommendations. Additionally, the writing committee reviewed documents related to ventricular arrhythmias (VA) and sudden cardiac death (SCD) previously published by the ACC, AHA, and the Heart Rhythm Society (HRS). References selected and published in this document are representative and not all-inclusive.As noted in the Preamble, an independent ERC was commissioned to perform a formal systematic review of 2 important clinical questions for which clear literature and prior guideline consensus were felt to be lacking or limited (Table 2). The results of the ERC review were considered by the writing committee for incorporation into this guideline. Concurrent with this process, writing committee members evaluated other published data relevant to the guideline. The findings of the ERC and the writing committee members were formally presented and discussed, then guideline recommendations were developed. The “Systematic Review for the 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death” is published in conjunction with this guideline.S1.4-1Table 2. Systematic Review Questions on SCD PreventionQuestion NumberQuestionSection Number1For asymptomatic patients with Brugada syndrome, what is the association between an abnormal programmed ventricular stimulation study and SCD and other arrhythmia endpoints?7.9.1.32What is the impact of ICD implantation for primary prevention in older patients and patients with significant comorbidities?10.3ICD indicates implantable cardioverter-defibrillator; and SCD, sudden cardiac death.The ACC and AHA have acknowledged the importance of value in health care and have called for eventual development of a Level of Value for clinical practice recommendations.S1.4-2 Available cost-effectiveness data were determined to be sufficient to support 2 specific recommendations in this guideline (see Sections 7.1.1 and 7.1.2). As a result, a Level of Value was assigned to those 2 recommendations on the basis of the “ACC/AHA Statement on Cost/Value Methodology in Clinical Practice Guidelines and Performance Measures,” as shown in Table 3.S1.4-2 Available quality of life (QoL) data were deemed to be insufficient to support specific recommendations in this guideline.Table 3. Proposed Integration of Level of Value Into Clinical Practice Guideline Recommendations*Level of ValueHigh value: Better outcomes at lower cost or ICER <$50 000 per QALY gainedIntermediate value: $50 000 to <$150 000 per QALY gainedLow value: ≥$150 000 per QALY gainedUncertain value: Value examined but data are insufficient to draw a conclusion because of no studies, low-quality studies, conflicting studies, or prior studies that are no longer relevantNot assessed: Value not assessed by the writing committeeProposed abbreviations for each value recommendation: Level of Value: H to indicate high value; I, intermediate value; L, low value; U, uncertain value; and NA, value not assessed*Dollar amounts used in this table are based on US GDP data from 2012 and were obtained from WHO-CHOICE Cost-Effectiveness Thresholds.S1.4-3GDP indicates gross domestic product; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-years; and WHO-CHOICE, World Health Organization Choosing Interventions that are Cost-Effective. Reproduced from Anderson, et al.S1.4-21.2. Organization of the Writing CommitteeThe writing committee consisted of cardiac electrophysiologists (including those specialized in pediatrics), general adult and pediatric cardiologists (including those specialized in critical care and acute coronary syndromes [ACS], genetic cardiology, heart failure, and cost-effectiveness analyses), a geriatrician with expertise in terminal care and shared decision-making, and a lay representative, in addition to representatives from the ACC, AHA, HRS, and the Heart Failure Society of America (HFSA).1.3. Document Review and ApprovalThis document was reviewed by 2 official reviewers nominated by the ACC, AHA, and HRS; 1 official lay reviewer nominated by the AHA; 1 organizational reviewer nominated by the HFSA; and 28 individual content reviewers. Reviewers’ RWI information was distributed to the writing committee and is published in this document (Appendix 2).This document was approved for publication by the governing bodies of the ACC, the AHA, and the HRS; and endorsed by the HFSA.1.4. Scope of the GuidelineThe purpose of this AHA/ACC/HRS document is to provide a contemporary guideline for the management of adults who have VA or who are at risk for SCD, including diseases and syndromes associated with a risk of SCD from VA. This guideline supersedes the “ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.”S1.4-4 It also supersedes some sections of the “ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities,”S1.4-5 specifically those sections on indications for the implantable cardioverter-defibrillator (ICD); and, it updates the SCD prevention recommendations in the “2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy.”S1.4-6 Some recommendations from the earlier guidelines have been updated as warranted by new evidence or a better understanding of existing evidence, and irrelevant or overlapping recommendations were deleted or modified.In the current guideline, sudden cardiac arrest (SCA) is defined as the “sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation.”S1.4-7 If corrective measures are not taken rapidly, this condition progresses to SCD. Cardiac arrest is used to signify an event that can be reversed, usually by cardiopulmonary resuscitation (CPR), administration of medications and/or defibrillation or cardioversion. SCA and SCD can result from causes other than VA, such as bradyarrhythmias, electromechanical dissociation, pulmonary embolism, intracranial hemorrhage, and aortic dissection; however, the scope of this document includes only SCA and SCD due to VA.This guideline includes indications for ICDs for the treatment of VA and prevention of SCD, but it does not delve into details on individual device selection and programming, including considerations relevant to cardiac resynchronization therapy (CRT), bradycardia pacing, and hemodynamic monitoring. These important aspects of ICD management have been covered in an HRS expert consensus statement.S1.4-8 An AHA science advisory discusses the use of wearable cardioverter-defibrillators.S1.4-9 The findings of that document were reviewed; however, recommendations on this topic were developed independently of that document. This guideline includes indications for catheter ablation of VA, but does not provide recommendations on specific techniques or ablation technologies, which were beyond the scope of this document.Recommendations for interventional therapies, including ablation and the implantation of devices, apply only if these therapies can be implemented by qualified clinicians, such that outcomes consistent with published literature are a reasonable expectation. The writing committee agreed that a high degree of expertise was particularly important for performance of catheter ablation of VA, and this point is further emphasized in relevant sections. In addition, all recommendations related to ICDs require that meaningful survival of >1 year is expected; meaningful survival means that a patient has a reasonable quality of life and functional status.Although this document is aimed at the adult population (≥18 years of age) and offers no specific recommendations for pediatric patients, some of the literature on pediatric patients was examined. In some cases, the data from pediatric patients beyond infancy helped to inform this guideline.The writing committee recognized the importance of shared decision-making and patient-centered care and, when possible, it endeavored to formulate recommendations relevant to these important concepts. The importance of a shared decision-making process in which the patient, family, and clinicians discuss risks and benefits of diagnostic and treatment options and consider the patients’ personal preferences is emphasized (see Section 15).In developing this guideline, the writing committee reviewed previously published guidelines and related statements. Table 4 contains a list of guidelines and statements deemed pertinent to this writing effort and is intended for use as a resource, obviating repetition of existing guideline recommendations.Table 4. Associated Guidelines and StatementsTitleOrganizationPublication Year (Reference)Guidelines SyncopeACC/AHA/HRS2017S1.4-10 Heart failureACCF/AHA2017S1.4-11 2016,S1.4-12 and 2013S1.4-13 Valvular heart diseaseAHA/ACC2017S1.4-14 and 2014S1.4-15 Supraventricular tachycardiaACC/AHA/HRS2015S1.4-16 Ventricular arrhythmias and the prevention of sudden cardiac deathESC2015S1.4-17 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular careAHA2015S1.4-18 Atrial fibrillationAHA/ACC/HRS2014S1.4-19 Non–ST-elevation acute coronary syndromesAHA/ACC2014S1.4-20 Assessment of cardiovascular riskACC/AHA2013S1.4-21 ST-elevation myocardial infarctionACCF/AHA2013S1.4-22 Acute myocardial infarction in patients presenting with ST-segment elevationESC2012S1.4-23 Device-based therapies for cardiac rhythm abnormalitiesACCF/AHA/HRS2012S1.4-24 Coronary artery bypass graft surgeryACCF/AHA2011S1.4-25 Hypertrophic cardiomyopathyACCF/AHA2011S1.4-6 Percutaneous coronary interventionACCF/AHA/SCAI2011S1.4-26 Secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular diseaseAHA/ACCF2011S1.4-27Scientific Statements Wearable cardioverter-defibrillator therapy for the prevention of sudden cardiac deathAHA2016S1.4-9 Optimal implantable cardioverter defibrillator programming and testingHRS/EHRA/APHRS/SOLAECE2016S1.4-8 Treatment of cardiac arrest: current status and future directions: strategies to improve cardiac arrest survivalIOM2015S1.4-28 Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalitiesACC/AHA2015S1.4-29 Ventricular arrhythmiasEHRA/HRS/APHRS2014S1.4-30 Arrhythmias in adult congenital heart diseasePACES/HRS2014S1.4-31 Implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trialsHRS/ACC/AHA2014S1.4-32 Cardiac sarcoidosisHRS2014S1.4-33 Inherited primary arrhythmia syndromesHRS/EHRA/APHRS2013S1.4-34ACC indicates American College of Cardiology; ACCF, American College of Cardiology Foundation; AHA, American Heart Association; APHRS, Asia Pacific Heart Rhythm Society; EHRA, European Heart Rhythm Association; ESC, European Society of Cardiology; HRS, Heart Rhythm Society; PACES, Pediatric and Congenital Electrophysiology Society; SCAI, Society for Cardiovascular Angiography and Interventions; and, SOLAECE, Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia.During final production review of the guidelines, several recommendations were refined to better reflect the data and current recommended medical practice. These refinements were reviewed and approved by the writing committee, the Task Force, and ACC, AHA, and HRS organizational leadership. These recommendations were:Section 7.1.1., recommendation 1Section 7.1.3., recommendation 2Section 7.2.1., recommendation 1Section 7.9.1.4., recommendation 2Section 10.8., recommendation 6Readers should refer to these sections for the updated text.1.5. AbbreviationsAbbreviationMeaning/PhraseACSacute coronary syndromesAEDautomated external defibrillatorAMIacute myocardial infarctionBNPB-type natriuretic peptideCABGcoronary artery bypass graftCKDchronic kidney diseaseCPRcardiopulmonary resuscitationCRTcardiac resynchronization therapyCTcomputed tomographyECGelectrocardiogramERCevidence review committeeESRDend-stage renal diseaseGDMTguideline-directed management and therapyHCMhypertrophic cardiomyopathyHFheart failureHFpEFheart failure with preserved ejection fractionHFrEFheart failure with reduced ejection fractionICDimplantable cardioverter-defibrillatorLVleft ventricularLVADleft ventricular assist deviceLVEFleft ventricular ejection fractionMImyocardial infarctionNICMnonischemic cardiomyopathyNSVTnonsustained ventricular tachycardiaPETpositron emission tomographyPCIpercutaneous coronary interventionPVCpremature ventricular complexQoLquality of lifeRCTrandomized controlled trialRVright ventricularRVOTright ventricular outflow tractSCAsudden cardiac arrestSCDsudden cardiac deathSVTsupraventricular tachycardiaTOFtetralogy of FallotVAventricular arrhythmiaVTventricular tachycardia2. Epidemiology2.1. General ConceptsTable 5. Table of Definitions of Commonly Used Terms in this DocumentTermDefinition or DescriptionVentricular tachycardiaS2.2.2-2Cardiac arrhythmia of ≥3 consecutive complexes originating in the ventricles at a rate >100 bpm (cycle length: <600 ms). Types of VT:Sustained: VT >30 s or requiring termination due to hemodynamic compromise in <30 s.Nonsustained/unsustained: ≥3 beats, terminating spontaneously.Monomorphic: Stable single QRS morphology from beat to beat.Polymorphic: Changing or multiform QRS morphology from beat to beat.Bidirectional: VT with a beat-to-beat alternation in the QRS frontal plane axis, often seen in th