Comments on the 2022 guidelines of the ESC on ventricular arrhythmias and prevention of sudden cardiac death

With the new version of the ESC guidelines on the management of ventricular arrhythmias and sudden cardiac death, a practice-oriented update has emerged. This article discusses essential innovations against the background of the situation in Germany. The guidelines illustrate the increasing importance of multidisciplinary expertise in the diagnostics and treatment of ventricular arrhythmias. In addition to basic skills in cardiology, the implementation of the recommendations requires special knowledge of cardiac pathology, human genetics, cardiovascular imaging (especially cardiac MRI), and invasive electrophysiology (including catheter ablation). For the first time, recommendations for basic life support have been included in the guidelines. The importance of genetic testing and cardiac MRI imaging has been significantly enhanced. The ICD treatment remains the essential part of primary and secondary prophylaxis for sudden cardiac death, although the recommendation for primary prophylactic ICD treatment for patients with dilated cardiomyopathy has been downgraded and an individualized risk assessment is proposed instead. In addition to the LV function, the range of risk markers has been increasingly expanded. Risk scores are becoming more important. Catheter ablation has also been significantly upgraded. Especially in the case of idiopathic ventricular arrhythmias, it has predominantly become the first-line treatment. Catheter ablation is also given priority over drug-based antiarrhythmic treatment in ischemic cardiomyopathy with recurrent tachycardia on chronic amiodarone treatment. For many other patients, the ideal time for ablation treatment is less clearly defined. Current limits in the certainty of statements are presented as "gaps of evidence ".