North American and European cardiologists have reached consensus for the first time on management of ventricular arrhythmia and prevention of sudden cardiac death with the joint release of new guidelines by the American College of Cardiology, American Heart Association, and European Society of Cardiology.

The new Guidelines outline recommendations on evaluation and treatment of patients who have or may be at risk for ventricular arrhythmias. Evaluation includes noninvasive and invasive techniques such as electrocardiography and electrophysiological testing.

Possible therapies include drugs, devices, ablation, surgery, and revascularization. Acute and chronic therapies are addressed. Prognosis and management are individualized according to symptom burden and severity of underlying heart disease in addition to clinical presentation.

In addition to recommendations in patients with specific pathology, cardiomyopathy and heart failure, specific populations are also covered, such as athletes, pregnant women, and elderly and pediatric patients.

One of the key updates in the 2006 document is that implantation of devices now has a range of ejection fractions.

“Prior to this document,” said Douglas P. Zipes, MD, co-chair of the Guideline Writing Committee, “practitioners faced inconsistent recommendations for prophylactic implantable cardioverter-defibrillator implantation based on ejection fractions, for example. The inconsistencies occurred because clinical investigators chose different ejection fractions for enrollment in trials of therapy, average values of the ejection fraction have been substantially lower than the cut off value for enrollment and subgroup analysis of clinical trial populations based on ejection fraction have not been consistent in their implications. The result was substantial differences among guidelines.”

The Writing Committee also notes in the 2006 Ventricular Arrhythmia Guidelines that differences between the United States and Europe may modulate how recommendations are implemented. Guidelines are composed of recommendations based on the best available medical science; however, implementation of these recommendations will be affected by the financial, cultural, and societal differences among individual countries.

“We have consciously attempted to create a streamlined document that would be useful specifically to locate recommendations on the evaluation and treatment of patients who have or may be at risk for ventricular arrhythmias. We are pleased that this consensus document has the support of all the major cardiovascular societies in Europe and the US,” said A. John Camm, MD, European co-chair of the Guideline Writing Committee.

The executive summary will be published in the September 5 issues of the Journal of the American College of Cardiology and Circulation, as well as the first September issue of the European Heart Journal. The full-text guideline is posted on the ACC (www.acc.org), AHA (www.americanheart.org) and ESC (www.escardio.org) web sites.