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Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 September 25, 2018 e279 CLINICAL STATEMENTS AND GUIDELINES

1.5 Abbreviations

Abbreviation Meaning/Phrase ACS acute coronary syndromes AED automated external defibrillator AMI acute myocardial infarction BNP B-type natriuretic peptide CABG coronary artery bypass graft CKD chronic kidney disease CPR cardiopulmonary resuscitation CRT cardiac resynchronization therapy CT computed tomography ECG electrocardiogram ERC evidence review committee ESRD end-stage renal disease GDMT guideline-directed management and therapy HCM hypertrophic cardiomyopathy HF heart failure HFpEF heart failure with preserved ejection fraction HFrEF heart failure with reduced ejection fraction ICD implantable cardioverter-defibrillator LV left ventricular LVAD left ventricular assist device LVEF left ventricular ejection fraction MI myocardial infarction NICM nonischemic cardiomyopathy NSVT nonsustained ventricular tachycardia PET positron emission tomography PCI percutaneous coronary intervention PVC premature ventricular complex QoL quality of life RCT randomized controlled trial RV right ventricular RVOT right ventricular outflow tract SCA sudden cardiac arrest SCD sudden cardiac death SVT supraventricular tachycardia TOF tetralogy of Fallot VA ventricular arrhythmia VT ventricular tachycardia

2 EPIDEMIOLOGY

2.1 General Concepts

VA include a spectrum that ranges from premature ventricular complex (PVC) to ventricular fibrillation (VF), with a clinical presentation that ranges from a total lack of symptoms to cardiac arrest. Most life-threatening VA are associated with ischemic heart disease, particularly in older patients.S2.2.2-1 The risks of VA and SCD vary in specific populations with different underlying cardiac conditions, and with specific family history and genetic variants, and this variation has important implications for studying and applying therapies.

2.1.1. Premature Ventricular Complexes and Nonsustained VT PVCs are common and increase in frequency with age. Although PVCs were found in a healthy military population in only 0.6% of those  <20 years of age and 2.7% of those >50 years of ageS2.2.2-5 on 12-lead ECGs, longer term monitoring shows PVCs in about 50% of all people with or without heart disease.S2.2.2-6 The presence of PVCs on 2 minutes of monitoring of middle-aged patients in the ARIC (Atherosclerosis Risk In Communities) study was associated with increased risk of both ischemic heart disease events and mortality, with or without prevalent ischemic heart disease.S2.2.2-7,S2.2.2-8 In the general population, frequent PVCs, which are defined as the presence of at least 1 PVC on a 12-lead ECG or >30 PVCs per hour, are associated with increased cardiovascular risk and increased mortality.S2.2.2-9 In a study from Taiwan of patients without sustained VT or structural heart disease who had 24-hour Holter monitoring for clinical evaluation, multifocal PVCs were associated with increased risk of death and nonfatal cardiovascular adverse outcomes.S2.2.2-10 In the same population, nonsustained ventricular tachycardia (NSVT) was independently associated with increased risk of death and other cardiovascular adverse outcomes, including stroke.S2.2.2-11 An association of PVCs with increased risk of stroke was also seen in the ARIC population.S2.2.2-8 Because some studies have shown an association of PVCs with adverse outcomes, the detection of PVCs, particularly if multifocal and frequent, is generally considered a risk factor for adverse cardiovascular outcomes, and such patients are generally evaluated to ensure they do not have underlying conditions (eg, ischemic heart disease, left ventricular [LV] dysfunction) that warrant further treatment to reduce risk. PVC and NSVT in patients with cardiovascular disease are common and have been associated with adverse outcomes.S2.2.2-12,S2.2.2-13 In CAST (Cardiac Arrhythmia Suppression Trials), treatment of patients with post-myocardial infarction (MI) who took antiarrhythmic medications (eg, flecainide, encainide, moricizine) increased the risk of death despite suppression of VA.S2.2.2-14,S2.2.2-15 Treatment of PVCs with antiarrhythmic medications has not been shown to reduce mortality and, in the post-MI population, treatment with class I sodium channel–blocking medications (eg, quinidine, flecainide) increases the risk of death.S2.2.2-15,S2.2.2-16 Likewise, in patients with a reduced LVEF class I, sodium channel–blocking medications and d-sotalol increase the  risk of death.S2.2.2-16,S2.2.2-17 Beta blockers, nondihydropyridines calcium channel block-

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