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September 25, 2018 Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 e306 CLINICAL STATEMENTS AND GUIDELINES III: Harm C-LD 5. In patients with incessant VT or VF, an ICD should not be implanted until sufficient control of the VA is achieved to prevent repeated ICD shocks.S7.1.3-14 III: No Benefit C-LD 6. In patients with ischemic heart disease and sustained monomorphic VT, coronary revascularization alone is an ineffective therapy to prevent recurrent VT.S7.1.3-15,S7.1.3-16 Recommendation-Specific Supportive Text 1. The most common antiarrhythmic medications used for suppression of VA include amiodarone and sotalol, while mexiletine, quinidine, and ranolazine are occasionally used.S7.1.3-17,S7.1.3-18 Amiodarone appears to be more effective than sotalol and has a low rate of ventricular proarrhythmia, but has an increased risk of medication-related adverse effects that lead to its discontinuation in many patients within 18 to 24 months from initiation of therapy.S7.1.3- 1,S7.1.3-19 Data supporting effectiveness of sotalol for suppression of VA are conflicting, but given its more favorable adverse effect profile than amiodarone, it may be a better first-line antiarrhythmic medication in appropriate patients.S7.1.3- 1–S7.1.3-3 However, sotalol is generally avoided in patients with a severely reduced LVEF <20% due to its negative inotropic effects and the risk of torsades de pointes. In a double-blind placebocontrolled study of 674 patients with HF and ≥10 PVCs/h and an LVEF ≤40% randomly assigned to receive amiodarone (336 patients) or placebo (338 patients), there was no significant difference in overall mortality or SCD between the 2 arms. There was a trend toward a reduction in overall Figure 5. Treatment of recurrent VA in patients with ischemic heart disease or NICM. Colors correspond to Class of Recommendation in Table 1. See Sections 5.6, 6, 7.1.3, and 7.2 for discussion. *Management should start with ensuring that the ICD is programmed appropriately and that potential precipitating causes, including heart failure exacerbation, are addressed. For information regarding optimal ICD programming, refer to the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement.S7.1.3-26 APHRS indicates Asia Pacific Heart Rhythm Society; EHRA, European Heart Rhythm Association; HRS, Heart Rhythm Society; IHD, ischemic heart disease; ICD, implantable cardioverter-defibrillator; PVC, premature ventricular complex; NICM, nonischemic cardiomyopathy; SOLAECE, Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología; VF, ventricular fibrillation; and VT, ventricular tachycardia. Recommendations for Treatment of Recurrent VA in Patients With Ischemic Heart Disease (Continued) COR LOE Recommendations Downloaded from http://ahajournals.org by on October 7, 2026