[Assessment of ventricular arrhythmias]

In the evaluation of patients with ventricular arrhythmias, those patients with asymptomatic ventricular arrhythmias, who usually comprise a low-risk population, have to be differentiated from patients with symptomatic ventricular arrhythmias (presyncopal symptoms, syncope, cardiac arrest). In general, patients with asymptomatic ventricular arrhythmias should not be treated with antiarrhythmic drugs; however, patients with recent myocardial infarction and asymptomatic ventricular arrhythmias, which may indicate an increased risk of sudden death, should undergo further risk stratification, since some of them might benefit from preventive antiarrhythmic therapy with a beta-blocking agent of amiodarone. In contrast to asymptomatic patients, patients with symptomatic ventricular arrhythmias are at high risk for sudden death, and, if functional status does not mandate against active therapy, these patients should undergo coronary angiography and electrophysiologic evaluation. Revascularization procedures and specific antiarrhythmic measures such as antiarrhythmic drug therapy, ablative therapy (surgical resection or transcatheter radiofrequency ablation of the arrhythmogenic focus) or the implantation of a cardioverterdefibrillator (ICD) are frequently needed in such patients. Consequently, in this high-risk population, early referral to a cardiac center with an electrophysiologic laboratory is recommended, whereas it should be strongly mandated against empirical antiarrhythmic drug therapy.