Ventricular arrhythmias. ICD

1. Big picture

Ventricular arrhythmias arise below the His bundle and range from benign premature ventricular complexes to ventricular tachycardia (VT), ventricular fibrillation (VF), cardiac arrest, and sudden cardiac death.

For the exam, the safest rule is:

Wide-complex tachycardia + structural heart disease = ventricular tachycardia until proven otherwise

The first clinical decision is not the exact mechanism; it is whether the patient has a pulse and whether they are unstable.

Pulseless VT/VF → CPR + unsynchronized defibrillation
VT with pulse but unstable → synchronized cardioversion
Stable VT → antiarrhythmic therapy + search for cause
Recurrent/high-risk VT/VF → consider ICD

The 2022 ESC guideline updated the management of ventricular arrhythmias and sudden cardiac death prevention, including new evidence for genetics, imaging, risk stratification, diagnostic evaluation, and therapies. ([European Society of Cardiology][1])

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