Diagnostic, pharmacological, and ablation approaches for idiopathic ventricular fibrillation: the 2024 European Heart Rhythm Association survey

The aim of the European Heart Rhythm Association (EHRA) physician-based survey was to assess current clinical practice regarding the diagnostic assessment and therapeutic management of idiopathic ventricular fibrillation (IVF) across European Society of Cardiology (ESC) countries and to evaluate adherence to the 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.

An online 24-item was developed and disseminated by the Scientific Initatives Committee of EHRA. A total of 206 physicians from 41 countries completed the questionnaire. Respondents declaring a full diagnostic assessment of IVF, including at least coronary angiogram/cardiac computed tomography scan, electrocardiogram monitoring, exercise stress test, pharmacological challenges, and cardiac magnetic resonance, were 71 (35%). Cardiac magnetic resonance, sodium channel blocker test, and genetic testing were reported by 51, 34, and 43%, respectively. The most preferred first-line therapeutic strategy in case of recurrent implantable cardioverter-defibrillator (ICD) shocks was drug therapy (88%). In case of first-line strategy failure, the preferred reported strategy was ablation (53%).

This survey highlights a significant heterogeneity of the diagnostic approach to IVF with underuse of crucial examinations. In line with guideline recommendation, drug therapy is more often considered as first-line therapy and ablation as second-line therapy for recurrent ICD shocks. However, quinidine is considered as drug of choice by <25% of respondents.