Correct. The risk of VA increases in patients with LVEF ≤ 35 % and implantable cardioverter-defibrillator (ICD) is recommended in such patients (Class I).

Correct. PES is a procedure used to induce and assess the risk of ventricular arrhythmias. It involves delivering programmed electrical stimuli to the heart to provoke arrhythmias under controlled conditions. In patients with cardiac sarcoidosis who have a LVEF 35–50% and minor late gadolinium enhancement (LGE) at CMR, after resolution of acute inflammation, PES for risk stratification should be considered (Class IIa).

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Correct. CMR is valuable for assessing myocardial scar and identifying areas of active inflammation or fibrosis. Late gadolinium enhancement (LGE) imaging detects myocardial scar tissue, which indicates prior inflammation and fibrosis in cardiac sarcoidosis. LGE-CMR can help stratify the risk of VA in patients with cardiac sarcoidosis.

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Correct. PET-CT is sensitive in identifying active inflammation detecting active inflammation of the myocardium. Therefore, it can help stratify the risk of VAs in such patients.

Correct. The risk of VA increases in patients with LVEF ≤ 35 % and implantable cardioverter-defibrillator (ICD) is recommended in such patients (Class I).

Correct. PES is a procedure used to induce and assess the risk of ventricular arrhythmias. It involves delivering programmed electrical stimuli to the heart to provoke arrhythmias under controlled conditions. In patients with cardiac sarcoidosis who have a LVEF 35–50% and minor late gadolinium enhancement (LGE) at CMR, after resolution of acute inflammation, PES for risk stratification should be considered (Class IIa).

Correct. CMR is valuable for assessing myocardial scar and identifying areas of active inflammation or fibrosis. Late gadolinium enhancement (LGE) imaging detects myocardial scar tissue, which indicates prior inflammation and fibrosis in cardiac sarcoidosis. LGE-CMR can help stratify the risk of VA in patients with cardiac sarcoidosis.

Correct. PET-CT is sensitive in identifying active inflammation detecting active inflammation of the myocardium. Therefore, it can help stratify the risk of VAs in such patients.

Incorrect. Idiopathic VTs are not associated with structural heart disease or scar-related re-entry mechanisms. They are often mediated by triggered activity or re-entry in specific regions of the heart, such as ventricular outflow tracts, papillary muscles, or Purkinje fibres.

Incorrect. There is always a risk of peri-procedural complications with any invasive procedure. However, catheter ablation is considered the primary treatment for idiopathic VTs and is usually curative - therefore it is reccommended.

Incorrect. The earliest site of VT activation is crucial for identifying the arrhythmogenic substrate. Ablation at the earliest activation site can effectively terminate the VT and prevent its recurrence.

Correct. Idiopathic VTs typically originate from specific regions of the heart, such as ventricular outflow tracts, papillary muscles, or Purkinje fibres. They are not associated with structural heart disease or scar-related re-entry mechanisms and they have a benign prognosis.

Incorrect. Sotalol is considered a well-tolerated AAD in pregnant women. It is often used for the management of arrhythmias during pregnancy due to its relatively safe profile.

Correct. Amiodarone is contraindicated in pregnant women due to its potential for causing fetal harm. It has been associated with thyroid dysfunction and neurodevelopmental abnormalities.

Incorrect. According to guidelines, bisoprolol is considered a medication to use if the potential benefit outweighs the potential risk in pregnant women. Although, bisoprolol may lead to intrauterine growth restriction, fetal bradycardia, neonatal hypoglycemia, and rarely neonatal respiratory depression.

Correct. Atenolol is contraindicated in pregnant women due to its potential for causing fetal harm. It has been associated with growth restriction, fetal bradycardia, and neonatal hypoglycemia.

The QT interval represents the duration of ventricular depolarization and repolarization on an ECG. Abnormalities in the QT interval prolongation is not a diagnostic criterion for early repolarization syndrome (ERS). ERS primarily involves abnormalities in the early phase of ventricular repolarization, typically manifested as J-point elevation in ECG leads.

Correct. J-point elevation ≥1mm is a diagnostic criterion for ERS. The prominent J-waves ≥ 2mm is a high-risk feature associated with ERS. The pattern is observed in patient who have experienced ventricular tachycardia or ventricular fibrillation without any heart disease.

Correct. The pattern is observed in patient who have experienced ventricular tachycardia or ventricular fibrillation without any heart disease.

Incorrect. The presence of atrial flutter on ECG recordings is not a diagnostic criterion for early repolarization syndrome (ERS). Atrial flutter is a specific type of atrial arrhythmia characterized by a rapid and regular atrial rhythm - flutter waves on ECG. ERS primarily involves abnormalities in ventricular repolarization, typically manifested as J-point elevation in specific ECG leads.

Incorrect. Brugada syndrome is associated with an increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias, especially ventricular fibrillation. However, immediate ICD placement is not recommended for all asymptomatic patients newly diagnosed with Brugada syndrome because the risk of malignant arrhythmia can vary. Guidelines typically reccommend ICD for symptomatic patients with a history of cardiac arrest, or with high-risk stratification such as documented spontaneous sustained ventricular tachycardia.

Incorrect. Regular exercise is beneficial for overall cardiac health, but there are no specific exercise recommendations to Brugada syndrome according to guidelines.

Correct. Current guidelines reccommend ICD placement in patients with Brugada syndrome who have experienced cardiac arrest or have survived sudden cardiac death due to ventricular arrhythmias. Brugada syndrome is characterized by a predisposition to ventricular arrhythmias, which can lead to sudden cardiac death. A previous cardiac arrest indicates a significant vulnerability to these life-threatening arrhythmias again.

Correct. Asymptomatic patients newly diagnosed with Brugada syndrome should undergo risk stratification using ECG markers (type 1 ECG pattern, early repolarization pattern, and QRS fragmentation). Regular follow-up appointments are important to monitor the patient's condition, assess for any changes in symptoms or ECG findings and adjust management strategies if necessary. Consideration of ICD placement may be appropriate for patients with high risk of sudden cardiac death.

Correct. In cases of regular wide QRS complex tachycardia, hemodynamic instability indicates that the patient's blood pressure and perfusion are compromised. Immediate cardioversion is necessary to restore sinus rhythm and stabilize the patient's hemodynamics.

Correct. In cases where the patient is hemodynamically stable and tolerating the tachycardia without significant symptoms, pharmacological intervention may be considered before cardioversion, especially in patients with anesthetic risk for cardioversion. In the PROCAMIO trial, Procainamide showed higher efficacy of ventricular tachycardia termination compared to amiodarone. However, in some European countries, procainamide might not be available - therefore amiodarone should be considered. Both medications are administered intravenously, allowing for rapid onset of action. According to ESC 2022 guidelines, the benefit of cardioversion should be weighed against risks related to anaesthesia, allowing procainamide/amiodarone administration. (Class IIa)

Incorrect. Digoxin is not used in the acute management of regular wide QRS complex tachycardia, especially if it is suspected to be ventricular. Digoxin is most commonly used for rate control in patients with rapid atrial fibrillation and is not effective for terminating ventricular arrhythmias.

Incorrect. Antiarrhythmic medications, such as procainamide or amiodarone, are commonly used for the termination of sustained monomorphic ventricular tachycardia in hemodynamically stable patients.

Incorrect. LQTS is characterized by prolongation of the QT interval on ECG. However, this single criterion of QTc > 460 ms is not sufficient enough for the diagnosis of LQTS.

Correct. LQTS is characterized by prolongation of the QT interval on ECG. This single criterion of QTc ≥ 480 ms is sufficient enough for the clinical diagnosis of LQTS according to ESC guidelines.

Correct. In the presence of arrhythmic syncope or cardiac arrest, a QTc≥460 ms is sufficient to consider a diagnosis of LQTS.

Incorrect. LQTS is characterized by prolongation of the QT interval on ECG. However, this single criterion of QTc > 450 ms is not sufficient enough for the diagnosis of LQTS.

Correct. If PVC burden is more than 20 %, there is a higher risk of left ventricle dysfunction development - therefore, catheter ablation may be considered (Class IIb). Patients with normal left ventricle function, who are manifested with symptoms, should be treated with catheter ablation as first-line therapy. Studies show that Catheter ablation of the PVCs is very efficient, with reported success rates of 75–90 %. (Class I)

Correct. Fascicular PVCs originate from the left or right bundle branches. Catheter ablation is recommended as it targets the specific area of the bundle branch where the PVCs are originating to eliminate further PVCs. (Class I). RVOT PVCs originate from the outflow tract of the right ventricle. Catheter ablation is reccommended for symptomatic RVOT PVCs that are refractory to medical therapy as the abnormal electrical pathway in the RVOT is identified and targeted for ablation - therefore preventing further PVCs. (Class I)

Correct. PVC-induced cardiomyopathy is a dilated cardiomyopathy with systolic dysfunction due to frequent PVCs. Catheter ablation of the PVCs is very efficient, with reported success rates of 75–90 %, and is considered first-line treatment for PVC-induced cardiomyopathy. (Class I)

Incorrect. A PVC burden of at least 10% appears to be the minimal threshold for development of PVC-induced cardiomyopathy, and the risk increases further with a PVC burden > 20%. Therefore, in asymptomatic patients with PVC burden lower than 10%, catheter ablation is not recommended.

Incorrect. Lidocaine does not significantly prolong the QT interval. Its mechanism of action involves blocking sodium channels, which stabilizes the cell membrane and reduces the excitability of cardiac tissues - therefore suppressing abnormal electrical activity in the ventricles. Lidocaine is not associated with an increased risk of TdP when used to treat ventricular arrhythmias.

Incorrect. Adenosine is not an antiarrhythmic medication commonly used for the treatment of ventricular arrhythmias. It is primarily indicated for the termination of certain supraventricular tachycardias, such as paroxysmal supraventricular tachycardia. The mechanism of action is by transiently blocking conduction through the atrioventricular node. Adenosine does not significantly affect the QT interval and is not associated with an increased risk of TdP.

Incorrect. Verapamil is a calcium channel blocker primarily used for the treatment of supraventricular arrhythmias and hypertension. It is not typically used for the treatment of ventricular arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Verapamil does not significantly prolong the QT interval

Correct. Amiodarone is a class III antiarrhythmic medication used for the treatment of ventricular arrhythmias. However, the side effect of amiodarone is the potential to prolong the QT interval - therefore increasing the risk of TdP. Prolongation of the QT interval is due to potassium channel blocking.

Incorrect. Flecainide is used for the treatment of supraventricular and ventricular arrhythmias. It works by inhibiting sodium channels - therefore slowing conduction through the heart.Flecainide can have extracardiac side effects, but typically do not include photosensitivity, corneal deposits, hypothyroidism, or pulmonary toxicity. Common extracardiac side effects of flecainide include central nervous system effects such as drowsiness, diplopia, headache.

Correct. Amiodarone has a lot of extracardiac side effects, which can include photosensitivity, corneal deposits, hypothyroidism (due to its high iodine content), and pulmonary toxicity. Other extracardiac side effects include hepatotoxicity, skin discoloration, and peripheral neuropathy.

Incorrect. Lidocaine is used for the treatment of ventricular arrhythmias. It is administered intravenously and acts by stabilizing the cardiac cell membrane - therefore preventing abnormal electrical activity. Lidocaine is not typically associated with extracardiac side effects such as photosensitivity, corneal deposits, hypothyroidism, or pulmonary toxicity. The effects are mainly cardiovascular and central nervous systems. Common side effects of lidocaine include drowsiness and dizziness.

Incorrect. Procainamide is blocking sodium channels and slowing conduction through the heart. It can have extracardiac side effects, but it typically does not include photosensitivity, corneal deposits, hypothyroidism, or pulmonary toxicity. Common extracardiac side effects of procainamide include rash, myalgia, vasculitis, systemic lupus and agranulocytosis.

Correct. BrS is a genetic disorder of the sodium channels of cardiomyocytes leading to abnormal electrical activity. Sodium channel blockers reduce sodium channel function - therefore exacerbating the electrical abnormalities and increasing the risk of ventricular fibrillation in patients with BrS.

Correct. Sodium channel blockers can affect myocardial contractility and can further depress left ventricular function by slowing down the rate of depolarization.

Correct. Sodium channel blockers can have proarrhythmic effects in patients with prior MI. Scarred myocardium from a prior MI is in risk of electrical conduction impairment. Sodium channel blockers may disrupt the balance of electrical conduction more - therefore increasing the risk of arrhythmias.

Incorrect. Sodium channel blockers stabilize the cardiomyocytes' membrane and slow down the rate of depolarization. In VT, where abnormal electrical impulses originating from the ventricles result in rapid and uncoordinated contraction, sodium channel blockers can normalize the electrical activity by slowing down the conduction of these abnormal impulses - therefore these drugs are indicated in patients with VT.

Incorrect. While cardioversion may be necessary in certain cases of ventricular arrhythmias, it is important to first consider withdrawing the offending drug if drug-induced arrhythmias are suspected. Cardioversion alone may not address the underlying cause and could lead to recurrence of the arrhythmia.

Incorrect. Increasing the dose of the offending drug is not recommended as this could worsen the arrhythmia and increase the risk of adverse effects.

Correct. When drug-induced arrhythmias are suspected, the first step is to withdraw the offending drug. Additionally, drugs with known prolongation og QT intervals, such as certain antiarrhythmic medications and antipsychotic drugs should be avoided.

Incorrect. Calcium gluconate is not typically used in the acute management of drug-induced ventricular arrhythmias. It is more commonly used in the treatment of hyperkalemia or calcium channel blocker toxicity.

Correct. Beta-blockers can cause bronchoconstriction by blocking beta-2 receptors in the lungs, leading to worsening of asthma symptoms such as wheezing and shortness of breath.

Correct. Beta-blockers can further decrease the conduction through the AV node, potentially worsening the heart block.

Incorrect. Beta-blockers shortens the QT interval by reducing the sympathetic effect - therefore beta-blockers might be administered to patients with long QT syndrome.

Correct. Beta-blockers can suppress the activity of the sinoatrial node, which is responsible for initiating the heart's electrical impulses. Beta-blockers can therefore further slow down the heart rate and could lead to sinus arrest.

Correct. SMVT is defined as continuous ventricular tachycardia lasting at least 30 seconds. This duration distinguishes it from non-sustained ventricular tachycardia, which typically lasts for less than 30 seconds.

Incorrect. SMVT is characterized by a regular, uniform morphology of the QRS complexes. In SMVT, the QRS morphology remains consistent from beat to beat, reflecting a stable and repetitive pattern of ventricular activation. On the other hand, Polymorphic ventricular tachycardia is characterized by a changing morphology of the QRS complexes.

Correct. SMVT is defined as continuous ventricular tachycardia lasting at least 30 seconds. This duration distinguishes it from non-sustained ventricular tachycardia, which typically lasts for less than 30 seconds. Non-sustained VT does not typically require intervention for termination.

Correct. SMVT is characterized by a regular, uniform morphology of the QRS complexes. In SMVT, the QRS morphology remains consistent from beat to beat, reflecting a stable and repetitive pattern of ventricular activation.

Correct. Electrical storm is a term used to describe a condition characterized by recurrent or sustained episodes (at least 3 episodes) of ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation, occurring in close succession (separated by at least 5 mins) over 24 hours. Each arrhythmia requiring intervention for termination. The defining characteristic of electrical storm is the repetitive and often refractory nature of the arrhythmias, leading to hemodynamic instability and an increased risk of sudden cardiac death.

Incorrect. Electrical storm is a term used to describe a condition characterized by recurrent or sustained episodes (at least 3 episodes) of ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation, occurring in close succession (separated by at least 5 mins) over 24 hours. Each arrhythmia requiring intervention for termination. The defining characteristic of electrical storm is the repetitive and often refractory nature of the arrhythmias, leading to hemodynamic instability and an increased risk of sudden cardiac death.

Incorrect. Electrical storm is a term used to describe a condition characterized by recurrent or sustained episodes (at least 3 episodes) of ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation, occurring in close succession (separated by at least 5 mins) over 24 hours. Each arrhythmia requiring intervention for termination. The defining characteristic of electrical storm is the repetitive and often refractory nature of the arrhythmias, leading to hemodynamic instability and an increased risk of sudden cardiac death.

Correct. Electrical storm is a term used to describe a condition characterized by recurrent or sustained episodes (at least 3 episodes) of ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation, occurring in close succession (separated by at least 5 mins) over 24 hours. Each arrhythmia requiring intervention for termination. The defining characteristic of electrical storm is the repetitive and often refractory nature of the arrhythmias, leading to hemodynamic instability and an increased risk of sudden cardiac death.

Incorrect. Bidirectional ventricular tachycardia has wide QRS complexes which alternate between two different axes on the ECG. This means that the electrical activation of the ventricles switches between two different pathways, leading to changes in the direction of the QRS complexes. Like other forms of ventricular tachycardia - wide QRS complexes indicate abnormal ventricular activation.

Correct. Bidirectional ventricular tachycardia has wide QRS complexes which alternate between two different axes on the ECG. This means that the electrical activation of the ventricles switches between two different pathways, leading to changes in the direction of the QRS complexes. Like other forms of ventricular

Correct. Bidirectional ventricular tachycardia has wide QRS complexes which alternate between two different axes on the ECG. This means that the electrical activation of the ventricles switches between two different pathways, leading to changes in the direction of the QRS complexes. Like other forms of ventricular arrhythmia, there is aberrant conduction through the ventricular myocardium - therefore QRS complexes are wide.

Correct. The pathophysiology of myocarditis usually involves an immune-mediated response that leads to inflammation and injury of the myocardium, which can subsequently disrupt normal cardiac electrical conduction and predispose to arrhythmias such as bidirectional ventricular tachycardia. The mechanisms could be from disruption of ion channels or impaired electrical conduction.

Correct. Acetylcholine is a neurotransmitter binding to cholinergic receptors - including receptors in the coronary arteries. In diagnostic testing, acetylcholine is administered intracoronary during cardiac catheterization to provoke coronary artery spasm. The administration of acetylcholine directly stimulates cholinergic receptors in the coronary arteries, causing vasodilation or in susceptible individuals vasospasm, which can be visualized during the procedure. This helps diagnose conditions like Prinzmetal angina or variant angina.

Incorrect. Ajmaline is class I antiarrhythmic drug. The mechanism of action is by blocking sodium channels, which slows electrical conduction. This can unmask certain electrical abnormalities, such as those seen in Brugada syndrome - characteristic ECG changes, particularly the type 1 Brugada ECG pattern, indicating a predisposition to malignant arrhythmias - therefore it is administered in Brugada syndrome diagnostic test.

Incorrect. Flecainide is class I antiarrhythmic drug. The mechanism of action is by blocking sodium channels, which slows electrical conduction. This can unmask certain electrical abnormalities, such as those seen in Brugada syndrome - characteristic ECG changes, particularly the type 1 Brugada ECG pattern, indicating a predisposition to malignant arrhythmias - therefore it is administered in Brugada syndrome diagnostic test.

Incorrect. Epinephrine (adrenaline) is a hormone and neurotransmitter that binds to adrenergic receptors including in the heart. During diagnostic testing, it is administered to induce arrhythmias like catecholaminergic polymorphic ventricular tachycardia (CPVT). Epinephrine increases heart rate, contractility, and conduction speed. In patients with CPVT or certain forms of sudden arrhythmia death syndrome (SADS), the increased adrenergic stimulation can trigger life-threatening arrhythmias, helping with the diagnosis.

Correct. Ajmaline is class I antiarrhythmic drug. The mechanism of action is by blocking sodium channels, which slows electrical conduction. This can unmask certain electrical abnormalities, such as those seen in Brugada syndrome - characteristic ECG changes, particularly the type 1 Brugada ECG pattern, indicating a predisposition to malignant arrhythmias - therefore it is administered in Brugada syndrome diagnostic test.

Incorrect. Epinephrine (adrenaline) is a hormone and neurotransmitter that binds to adrenergic receptors including in the heart. During diagnostic testing, it is administered to induce arrhythmias like catecholaminergic polymorphic ventricular tachycardia (CPVT). Epinephrine increases heart rate, contractility, and conduction speed. In patients with CPVT or certain forms of sudden arrhythmia death syndrome (SADS), the increased adrenergic stimulation can trigger life-threatening arrhythmias, helping with the diagnosis.

Incorrect. Adenosine is not typically administered for diagnosing Brugada Syndrome or Sudden Arrhythmia Death Syndrome. It is primarily administered for diagnosing and treating supraventricular tachycardia. The mechanism is by activating adenosine receptors which leads to inhibition of calcium influx into cardiomyocytes and hyperpolarization of the AV node - therefore transiently blocking conduction through the AV node.

Incorrect. Acetylcholine is a neurotransmitter binding to cholinergic receptors - including receptors in the coronary arteries. In diagnostic testing, acetylcholine is administered intracoronary during cardiac catheterization to provoke coronary artery spasm. The administration of acetylcholine directly stimulates cholinergic receptors in the coronary arteries, causing vasodilation or in susceptible individuals vasospasm, which can be visualized during the procedure. This helps diagnose conditions like Prinzmetal angina or variant angina.

Incorrect. Ajmaline is class I antiarrhythmic drug. The mechanism of action is by blocking sodium channels, which slows electrical conduction. This can unmask certain electrical abnormalities, such as those seen in Brugada syndrome - characteristic ECG changes, particularly the type 1 Brugada ECG pattern, indicating a predisposition to malignant arrhythmias - therefore it is administered in Brugada syndrome diagnostic test.

Correct. Epinephrine (adrenaline) is a hormone and neurotransmitter that binds to adrenergic receptors including in the heart. During diagnostic testing, it is administered to induce arrhythmias like catecholaminergic polymorphic ventricular tachycardia (CPVT). Epinephrine increases heart rate, contractility, and conduction speed. In patients with CPVT or certain forms of sudden arrhythmia death syndrome (SADS), the increased adrenergic stimulation can trigger life-threatening arrhythmias, helping with the diagnosis.

Incorrect. Flecainide is class I antiarrhythmic drug. The mechanism of action is by blocking sodium channels, which slows electrical conduction. This can unmask certain electrical abnormalities, such as those seen in Brugada syndrome - characteristic ECG changes, particularly the type 1 Brugada ECG pattern, indicating a predisposition to malignant arrhythmias - therefore it is administered in Brugada syndrome diagnostic test.

Incorrect. Acetylcholine is a neurotransmitter binding to cholinergic receptors - including receptors in the coronary arteries. In diagnostic testing, acetylcholine is administered intracoronary during cardiac catheterization to provoke coronary artery spasm. The administration of acetylcholine directly stimulates cholinergic receptors in the coronary arteries, causing vasodilation or in susceptible individuals vasospasm, which can be visualized during the procedure. This helps diagnose conditions like Prinzmetal angina or variant angina.

Incorrect. Ajmaline is class I antiarrhythmic drug. The mechanism of action is by blocking sodium channels, which slows electrical conduction. This can unmask certain electrical abnormalities, such as those seen in Brugada syndrome - characteristic ECG changes, particularly the type 1 Brugada ECG pattern, indicating a predisposition to malignant arrhythmias - therefore it is administered in Brugada syndrome diagnostic test.

Incorrect. Epinephrine (adrenaline) is a hormone and neurotransmitter that binds to adrenergic receptors including in the heart. During diagnostic testing, it is administered to induce arrhythmias like catecholaminergic polymorphic ventricular tachycardia (CPVT). Epinephrine increases heart rate, contractility, and conduction speed. In patients with CPVT or certain forms of sudden arrhythmia death syndrome (SADS), the increased adrenergic stimulation can trigger life-threatening arrhythmias, helping with the diagnosis.

Incorrect. Acetylcholine is a neurotransmitter binding to cholinergic receptors - including receptors in the coronary arteries. In diagnostic testing, acetylcholine is administered intracoronary during cardiac catheterization to provoke coronary artery spasm. The administration of acetylcholine directly stimulates cholinergic receptors in the coronary arteries, causing vasodilation or in susceptible individuals vasospasm, which can be visualized during the procedure. This helps diagnose conditions like Prinzmetal angina or variant angina.

Correct. Adenosine is administered for diagnosing and treating supraventricular tachycardia. The mechanism is by activating adenosine receptors which leads to inhibition of calcium influx into cardiomyocytes and hyperpolarization of the AV node - therefore transiently blocking conduction through the AV node. In addition to slowing AV node conduction, adenosine can also slow down the heart rate, causing transient bradycardia or even sinus pause. This can unmask any hidden pre-excitation by allowing more time for conduction through the accessory pathway - therefore making the delta wave more prominent on the ECG.

Correct. 12-lead ECG is considered a first-line evaluation for patients with newly documented VA because it can provide information about the morphology of the VA. (Class I)

Correct. Echocardiography is also a first-line evaluation because it can show cardiac function and potential structural heart disease - therefore helping in the assessment of patients with newly documented VA. (Class I)

Correct. CMR shloud be considered in specific cases, especially when structural heart disease other than coronary artery disease are suspected or when ECHO results are inconclusive. CMR can detect areas of fibrosis or scar tissue which may serve as substrates for VA. (Class IIa)

Correct. Holter monitoring is useful for assessing the frequency, duration, and morphology of VA. It is reccommended to monitor for at least 24 hours as it can provide correlates symptoms with arrhythmic events. (Class IIa)

Correct. Exercise testing can contribute to diagnosing LQTS by evaluating the QT interval during exercise and the recovery period (4-minute recovery). In LQTS, there is often abnormal prolongation of the QT interval during physical activity or stress due to adrenergic stimulation.

Incorrect. AFib is usually diagnosed via normal ECG recording, not exercise testing.

Correct. Idiopathic MVT refers to a type of ventricular arrhythmia characterized by a rapid and regular heart rate originating from a single focus in the ventricles. In patients with adrenergic-dependent rhythm disturbances, the heart rate increases and the myocardium experiences increased sympathetic tone during exercise - therefore it can trigger ventricular arrhythmias like MVT.

Correct. Exercise testing is also useful for detecting bidirectional VT in CPVT, which is a genetic condition with abnormal calcium handling in cardiomyocytes and can lead to bidirectional VT. This condition can be unmasked during exercise testing due to adrenergic stimulation.

Incorrect. Adenosine is a medication commonly used in the management of certain supraventricular tachycardias (SVT), such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT). It works by transiently blocking conduction through the atrioventricular node, thereby interrupting the reentrant circuit responsible for the SVT. It is not used in the management of SMVT because adenosine primarily affects the atrioventricular node and does not have a direct effect on ventricular myocardium. Administration of adenosine in patients with ventricular arrhythmias can potentially exacerbate the arrhythmia.

Correct. Sustained monomorphic ventricular tachycardia (SMVT) is characterized by rapid, regular ventricular contractions originating from a single focus in the ventricles. Synchronized cardioversion is the process of delivering an electrical energy to the heart synchronized with a specific phase of the cardiac cycle, typically the R-wave of the QRS complex. This synchronization helps to minimize the risk of inducing ventricular fibrillation and ensures the shock is delivered during the relative refractory period of the cardiac cycle, increasing its efficacy in terminating the arrhythmia. On the other hand - unsynchronized shocks have higher risk of inducing ventricular fibrillation. SMVT with hemodynamic instability therefore needs immediate synchronized cardioversion to restore normal sinus rhythm and hemodynamic functions (cardiac output and organ perfusion).

Incorrect. Beta-blockers are commonly used in the management of various cardiac arrhythmias, such as ventricular tachycardia (VT). They work by blocking the effects of adrenaline and other stress hormones on the heart, thereby reducing heart rate and oxygen demand by myocardium. However, in hemodynamically unstable sustained monomorphic ventricular arrhytmia (SMVT), beta-blockers are not reccommended for the initial management strategy because beta-blockers take time to make an effect and may not be sufficient enough to terminate the arrhythmia quickly. Beta-blockers may be used for treatment of stable VT or as a long-term therapy to prevent VT recurrence but in the case of hemodynamically unstable SMVT, the treatment should be quick normalization of sinus rhythm and hemodynamic functions - therefore immediate synchronized cardioversion is reccommended.

Incorrect. Administering intravenous fluids can help increase preload and cardiac output, especially if the patient is hypovolemic. Vasopressor support may be necessary to maintain blood pressure and organ perfusion. But in patients with sustained monomorphic ventricular tachycardia (SMVT) the hemodynamic instabilityis not caused by hypovolemia. The instability is caused by the arrhythmia itself - therefore immediate synchronized cardioversion is reccommended to terminate SMVT.

Correct. SQTS is a genetic heart rhythm disorder caused by mutations in genes that regulate ion channels - therefore genetic testing can identify these mutations and confirm SQTS. (Class I)

Correct. QTc is the time for ventricular depolarization and repolarization in the heart. It is recommended that SQTS is diagnosed in the presence of a QTc ≤ 360ms and one or more of the following: a pathogenic mutation, a family history of SQTS, or survival from a ventricular arrhythmia episode in the absence of heart disease. (Class I). QTc ≤ 320 ms alone is considered abnormally short and may indicate the presence of SQTS. (Class IIa). In SQTS, shortened QT intervals result from accelerated cardiac repolarization due to abnormalities in ion channels. This shortened repolarization can predispose individuals to ventricular arrhythmias.

Correct. Arrhythmic syncope are caused by rapid heart rhythms, which can occur in SQTS due to ventricular arrhythmias. Implanting an ICD in SQTS patients who experience arrhythmic syncope is reccommended to prevent sudden cardiac death. (Class IIa)

Correct. Electrical storms refer to recurrent episodes of ventricular arrhythmias within a short period. Isoproterenol is a beta-adrenergic agonist and increases heart rate and myocardial contractility by stimulating beta-adrenergic receptors in the heart, leading to increased calcium influx. This can help suppressing ventricular arrhythmias and stabilize the heart rhythm during electrical storms in SQTS patients.

Correct. CPVT is often caused by mutations in genes responsible for calcium handling in cardiomyocyte. Genetic testing helps confirm the diagnosis. (Class I)

Correct. Epinephrine (adrenaline) is a catecholamine and induces conditions similar to physical exercise. The challenge can provoke ventricular arrhythmias characteristic of CPVT. (Class IIb)

Correct. Beta-blockers block the effects of catecholamines on the heart, which helps prevent the occurrence of ventricular arrhythmias. By reducing the heart rate and inhibiting the response to sympathetic stimulation, beta-blockers decrease the chance of triggered arrhythmias in patients with CPVT. (Class I)

Correct. Isoproterenol is a beta-adrenergic agonist and increases heart rate and myocardial contractility by stimulating beta-adrenergic receptors in the heart, leading to increased calcium influx. The challenge can provoke ventricular arrhythmias characteristic of CPVT. (Class IIb)

Correct. Genetic form of LQTS is caused by genetic mutations of ion channels involved in repolarization - potassium channels (e.g., mutations in genes like KCNQ1, KCNH2, and SCN5A). (Class I)

Correct. Beta-blockers are reccommended for patients with LQTS because they reduce the risk of arrhythmic events by slowing down the heart rate and decreasing sympathetic tone. (Class I)

Incorrect. Routine diagnostic testing with epinephrine challenge is not recommended in LQTS. Epinephrine (adrenaline) provoke an adrenaline-induced stress response and unmask latent LQTS. However, this can induce dangerous arrhythmias (ventricular fibrillation) in patients with LQTS. (Class III)

Correct. Mexiletine is a class IB antiarrhythmic medication that may be prescribed for patients with LQTS subtype 3, characterized by persistent inward sodium current. Mexiletine stabilize cardiac cell membranes, reducing the risk of arrhythmias in patients with a prolonged QT interval. (Class I)

Incorrect. Catheter ablation uses radiofrequency energy to destroy small areas of abnormal heart tissue causing arrhythmias. In Brugada syndrome, the arrhythmias typically start from the right ventricular outflow tract (RVOT). However, the risk of arrhythmias and sudden cardiac death in asymptomatic BrS patients is relatively low compared to symptomatic patients - therefore it is not reccommended to use ablation in asymptomatic patients. (Class III)

Incorrect. BrS is characterized by a specific ECG pattern known as type 1 Brugada pattern (coved ST-segment elevation followed by negative T-wave in the right precordial leads V1-V3). In patients with a documented type 1 Brugada pattern, the diagnosis of BrS is already made. Administering a sodium channel blocker in such patients does not provide additional diagnostic information. It may be a risk to provoke arrhythmias, such as ventricular tachycardia or ventricular fibrillation. (Class III)

Correct. Genetic testing for SCN5A gene is recommended for probands with suspected BrS (patients who are the first to show a particular genetic mutation), not for all patients with suspected BrS. The SCN5A gene encodes for the alpha subunit of the cardiac sodium channel causing BrS. Genetic testing helps identifying mutations in genes associated with BrS - therefore helping with diagnosis and is a form of family screening. (Class I)

Correct. Brugada syndrome is characterized by abnormal electrical activity of the heart that can lead to ventricular arrhythmias and sudden cardiac death. Some patients may experience syncope, which can be difficult to capture on standard ECGs. Implantation of a loop recorder (a small device that continuously monitors the heart's rhythm) can help to capture and diagnose these arrhythmias. (Class IIa)

Incorrect. Chronic structural diseases such as CAD, valvular heart diseases, and heart failure predominate in older populations rather than in patients under the age of 50.

Incorrect. Although CAD, especially acute coronary syndrome, becomes a significant cause of SCD in individuals in their fourth decade, it is not the predominant cause in individuals under the age of 50.

Incorrect. Myocarditis is one of the causes of SCD in young individuals, but it is not the predominant cause.

Correct. Primary electric diseases are predominant causes of SCD in young individuals.

Correct. ICD is reccommended in patients with cardiac sarcoidosis and LVEF ≤ 35 %. These patients have an increased risk of sudden cardiac death. ICD can terminate malignant arrhythmias and prevent sudden cardiac death in these patients. (Class I)

Incorrect. Patients with LVEF > 50% do not meet the criteria for ICD. The risk of sudden cardiac death is generally lower in this population compared to those with reduced LVEF - therefore, ICD is not reccommended in these patients.

Correct. Sustained VT frequently develops in the advanced stage of cardiac sarcoidosis. Sustained VT increases the risk of malignant arrhythmias and sudden cardiac death - therefore, ICD is reccommended in these patients.(Class I)

Correct. Significant LGE on CMR indicates myocardial fibrosis or scar tissue, which can predispose to ventricular arrhythmias - therefore, ICD may be considered for prevention of sudden cardiac death. (Class IIa)

Correct. AFib is a common arrhythmia characterized by rapid, irregular electrical activity in the atria of the heart, leading to an irregular heartbeat. It can have genetic components, but it is often a multifactorial condition influenced by a combination of genetic predisposition, environmental factors, and other health conditions - therefore genetic testing is not reccommended in these patients.

Incorrect. Genetic testing for SCN5A gene is recommended for probands with suspected BrS (patients who are the first to show a particular genetic mutation), not for all patients with suspected BrS. The SCN5A gene encodes for the alpha subunit of the cardiac sodium channel causing BrS. Genetic testing helps identifying mutations in genes associated with BrS - therefore helping with diagnosis and is a form of family screening. (Class I)

Incorrect. CPVT is a rare genetic disorder characterized by abnormal heart rhythms triggered by physical activity or emotional stress. It typically presents with exercise-induced syncope, palpitations, or sudden cardiac arrest in young individuals. Genetic testing is recommended for CPVT because it is primarily a genetic disorder caused by mutations in genes affecting calcium handling in cardiomyocytes. (Class I)

Incorrect. Genetic form of LQTS is caused by genetic mutations of ion channels involved in repolarization - potassium channels (e.g., mutations in genes like KCNQ1, KCNH2, and SCN5A). (Class I)

Incorrect. Oral AADs, other than beta-blockers, are not reccommended for prophylactic treatment of VA in ACS. Many AADs have proarrhythmic effects and may increase mortality in patients with ACS. Oral AADs take time to reach therapeutic levels in the bloodstream, therefore less suitable for acute management of VA during ACS. (Class III)

Correct. Lidocaine is a class Ib antiarrhythmic drug that blocks voltage-gated sodium channels and therefore stabilizing the membrane and decreasing excitability of cyrdiomyocytes. It is often considered as a second-line agent when beta-blockers or amiodarone fail to control recurrent VA in ACS. (Class IIb)

Correct. Beta-blockers are recommended for the management of VA in ACS. Beta-blockers inhibit the effects of catecholamines on beta-adrenergic receptors of the heart, thus decreasing the heart rate, reduce myocardial oxygen demand, and suppress abnormal automaticity and triggered activity in the ventricles. (Class I)

Correct. Amiodarone is a class III antiarrhythmic drug. It prolongs the action potential duration and refractory period in cardiomyocytes, which helps in controlling VA. In the acute phase of ACS, intravenous amiodarone may be used to stabilize and control recurrent VA. (Class IIa)

Incorrect. Randomized trials DINAMIT and IRIS show that prophylactic ICD within the first 40 days after MI does not significantly reduce mortality.

Correct. Reevaluation of LVEF is recommended after 40 days post-MI to assess the need for ICD implantation. This helps to identify patients who may benefit from ICD therapy based on their LVEF. (Class I)

Correct. Randomized trials DINAMIT and IRIS show that prophylactic ICD within the first 40 days after MI does not significantly reduce mortality.

Incorrect. PES is a technique used during electrophysiology studies to assess the risk of ventricular arrhythmias, especially in patients with MI. PES involves pacing the heart at different rates and inducing arrhythmias to evaluate the heart's electrical properties and susceptibility to ventricular tachycardia (VT) or ventricular fibrillation (VF). There is ongoing research investigating the utility of PES in identifying high-risk patients (PROTECT-ICD) but this intervention is not in the current guidelines.

Incorrect. Amiodarone is a class III antiarrhythmic medication that primarily prolongs the action potential and refractory period in cardiomyocytes. Amiodarone is not recommended as a first-line treatment for idiopathic VT/PVCs due to its potential for serious side effects. (Class III)

Correct. RVOT VT is characterized by abnormal electrical activity originating from the right ventricular outflow tract. These patients could be treated with beta-blockers. Beta-blockers inhibits the effect of catecholamines on beta-1 receptors. This is beneficial in RVOT VT because many episodes of ventricular tachycardia are triggered by sympathetic stimulation such as anxiety and excitement. But catheter ablation still may be considered in symptomatic patients despite pharmacological therapy. (Class I)

Correct. Catheter ablation to selectively destroy or isolate the abnormal cardiac tissue responsible for generating arrhythmias. Catheter ablation is considered the first-line treatment for symptomatic idiopathic VT/PVCs originating from the RVOT. It offers a high success rate and potential for symptom resolution without the need for long-term medication. (Class I)

Correct. Adenosine or vagal manoeuvres can be used as a first line therapy to differentiate between supraventricular tachcardia (SVT) and RVOT VT in patients with regular wide QRS complex tachycardia. (Class II)

Incorrect. Amiodarone is an antiarrhythmic medication commonly used in the management of ventricular arrhythmias, including VF. But the administration is not reccommended immediately. The priority in VF is to quickly defibrillate and initiate CPR to restore circulation and oxygenation.

Correct. A patient with ventricular fibrillation (VF) is in risk of life. VF is a life-threatening cardiac arrhythmia characterized by rapid and chaotic ventricular contractions. Immediate initiation of CPR is crucial. CPR helps maintain blood circulation and oxygenation to vital organs until a defibrillator can be used to restore a normal heart rhythm.

Correct. An automated external defibrillator (AED) is a portable device that can analyze the heart rhythm and give an electrical shock if VF is detected. Defibrillation is the definitive treatment for ventricular fibrillation. When a patient is in VF, the heart's electrical activity is disorganized and the heart is unable to pump blood effectively. Defibrillation gives an electrical shock to the heart, temporarily depolarizing the myocardium and allowing the heart's natural pacemaker to regain control and to restore normal sinus rhythm.

Incorrect. Adenosine is not indicated in the management of ventricular fibrillation. Adenosine is primarily used for the termination of certain supraventricular tachycardias. It transiently blocks conduction through the atrioventricular node. It does not affect ventricular myocardium - therefore it is not reccommended in the immediate management of VF.

Correct. Catheter ablation is indicated in patients with IVF and recurrent episodes of VF triggered by a similar premature ventricular contractions (PVCs) non-responsive to medical treatment. Catheter ablation targets the site of origin of PVCs to interrupt the arrhythmia circuit and prevent its recurrence. It is considered as an effective treatment for these patients. (Class IIa)

Correct. Quinidine should be considered for chronic therapy to suppress an electrical storm or recurrent ICD discharges in idiopathic VF (Class IIa). It blocks sodium channels in cardiomyocytes, slowing the rate of depolarization, which can help stabilize the electrical activity.

Correct. Isoproterenol infusion or verapamil should be considered for acute treatment of an electrical storm or recurrent ICD discharges in idiopathic VF (Class IIa).

Correct. ICD is a device implanted in patients at risk of sudden cardiac death due to ventricular arrhythmias such as ventricular fibrillation (VF) or ventricular tachycardia (VT). ICD continuously monitors the heart's rhythm and deliver shocks or pacing to terminate life-threatening arrhythmias and restore normal heart rhythm. In patients with IVF, studies have shown that ICD can significantly reduce the risk of arrhythmic death by up to 68% compared to amiodarone. (Class I)

Correct. This makes an importance of further investigation for athletes who have risk factors for cardiovascular diseases. Positive medical history, abnormal physical examination findings or abnormal ECG may indicate hidden cardiac issues that could predispose athletes to SCD. (Class I)

Correct. These guidelines set out rules for safe participation in sports activities based on the specific cardiovascular condition. The goal is to minimize the risk of SCD during peak physical activity. (Class I)

Correct. Training staff at sporting facilities in CPR and automated-external defibrillator (AED) is essential for a quick and effective help or treatment in SCD. (Class I)

Correct. Pre-participation cardiovascular evaluation is reccommended for competitive athletes because it allows the identification of athletes at risk of SCD. This evaluation includes medical history review, physical examination and ECG screening. (Class IIa)

Incorrect. ICD is not recommended for all patients with ventricular arrhythmias (VA). It is indicated for patients with high risk of sudden cardiac death due to VA. For example, patients who have survived cardiac arrest or those with significant left ventricular dysfunction despite optimal medical therapy.

Incorrect. ICD is not contraindicated in patients with a history of ventricular fibrillation (VF). VF is one of the indications for ICD.

Correct. ICD is reccommended for patients who have an expectation of good quality survival beyond one year. This considers patient's overall health and comorbidities. (Class I)

Incorrect. It is not recommended to implant an ICD in patients with incessant ventricular arrhythmias without a sufficient control of the arrhythmia. Incessant ventricular arrhythmias may indicate an unstable condition, such as myocardial ischemia, electrolyte disturbances or drug toxicity. These conditions must be treated properly before considering ICD. (Class III).

Correct. Excessive ventricular pacing can lead to pacing-induced cardiomyopathy. By allowing the intrinsic heart rhythm to prevail whenever possible, the device programming can better mimic the natural cardiac function - therefore reducing the risk of pacing-induced cardiomyopathy. (Class I)

Correct. This threshold (188 b.p.m. - Advance III trial) ensures quick delivery of the shock when the heart rate exceeds the predefined limit. This is important in preventing sudden cardiac death due to ventricular arrhythmias by terminating potentially malignant arrhythmias. (Class I)

Correct. The detection settings help differentiate between clinically significant arrhythmias requiring intervention and non-sustained arrhythmias that may not need therapy - therefore the therapy is delivered only when necessary and the device programming can reduce the risk of inappropriate shocks and improve patient outcomes. (Class I)

Correct. ATP therapy goal is to terminate ventricular tachycardia by pacing the heart at a rapid rate. This helps to restore normal sinus rhythm without the need for shocks - therefore the device programming can reduce patient discomfort associated with shocks. (Class I)

Incorrect. Participation in high-intensity exercise, including competitive sports, is not reccommended for patients with DCM or HNDCM and LMNA gene mutation. LMNA mutations are associated with an increased risk of cardiac arrhythmias and sudden cardiac death during physical exertion. (Class III)

Correct. ICD implantation is recommended in patients with DCM or HNDCM, who survive sudden cardiac arrest (SCA) due to ventricular tachycardia (VT) or ventricular fibrillation (VF) or experience haemodynamicallynot-tolerated sustained monomorphic ventricular tachycardia (SMVT). The goal for ICD is to prevent sudden cardiac death by terminating VT, VF, SMVT - therefore patients who have already experienced such events are considered high-risk and may benefit from ICD. (Class I)

Correct. DCM and HNDCM can have genetic etiology. Testing for mutations in specific genes like LMNA, PLN, RBM20, and FLNC can help identify patients and provide further treatment and family screening. (Class I)

Correct. Screening of first-degree relatives with an ECG and ECHO is recommended if the index patient was diagnosed with DCM or HNDCM before the age of 50 years or if there is a family history of DCM or HNDCM or premature unexpected sudden death. (Class I)

Correct. CMR is recommended for patients with suspected ARVC to determine the diagnosis. CMR provides high-resolution images of the heart. It shows detailed cardiac morphology, function, and tissue characteristics. In ARVC, CMR can detect characteristic image like right ventricular dilation, regional wall motion abnormalities, fibrous and fat infiltration and myocardial scarring. (Class I)

Incorrect. ECHO is good for assessing cardiac structure and function, including chamber size, wall thickness and the presence of any structural abnormalities. However, ECHO may not be as sensitive or specific as cardiac magnetic resonance (CMR) for diagnosing ARVC.

Incorrect. CT scan can provide detailed morphological information about the heart. However, CT scan may not be as sensitive or specific as CMR for assessing myocardial tissue characteristics such as fibrous and fatty infiltration and myocardial scarring in ARVC.

Incorrect. X-ray imaging may be used to evaluate cardiac size and shape, but it is not used as a primary diagnostic tool for ARVC. X-ray cannot visualize fibrous and fatty infiltration and myocardial scarring in ARVC.

Incorrect. Sudden Infant Death Syndrome (SIDS) is not limited to infants younger than six months and is not caused by a specific medical condition. SIDS can occur in infants up to one year old and no known specific medical condition is the cause of death.

Incorrect. Accidental suffocation during sleep can lead to sudden infant death. However, SIDS refers to cases where no known cause of death can be identified.

Incorrect. SIDS is multifactorial and there is a role of genetic, environmental and developmental factors.

Correct. The definition, according to guidelines, is unexplained sudden death

Correct. Signal-averaged ECG is capable of detecting low-amplitude signals ("late potentials") in the terminal QRS segment. Late potentials are small electrical signals that occur at the end of the QRS complex and could be a sign of delayed and fragmented ventricular activation. This may not be clear on a standard ECG but can be detected using signal-averaged ECG. Abnormalities in the signal-averaged ECG such as prolonged low-amplitude signal duration or reduced root mean square voltage of the terminal 40 ms QRS can indicate an increased risk of ventricular arrhythmias.

Incorrect. Signal-averaged ECG primarily focuses on detecting abnormalities in the QRS complex but not the P waves.

Correct. Signal-averaged ECG is useful in diagnosing ARVC. ARVC is a genetic disease characterized by fibrous and fatty replacement of the right ventricular myocardium. This leads to ventricular arrhythmias and risk of sudden cardiac death. Signal-averaged ECG can contribute to the diagnosis of ARVC by detecting abnormalities in the terminal QRS segment (prolonged low-amplitude signal duration or reduced root mean square voltage), which are signs of delayed and fragmented ventricular activation.

Incorrect. Signal-averaged ECG is not primarily used to detect high-amplitude signals in the QRS complex. It is designed to detect low-amplitude signals in the QRS complex.

Correct. QTc prolongation reflects delayed ventricular repolarization. In patients with MVP, QTc prolongation has been associated with an increased risk of SCD by the risk of the development of ventricular arrhythmias (e.g. torsades de pointes). This arrhythmia can lead to ventricular fibrillation and then to SCD.

Correct. Mitral annular disjunction is a separation of the mitral valve annulus from the left ventricle myocardium during systole. Mitral annular disjunction can lead to mechanical stretch and distortion of the ventricle myocardium, which may promote myocardial fibrosis and scar formation - therefore create a substrate for reentrant ventricular arrhythmias and increasing the risk of SCD. Additionally, the separation of the mitral annulus from the myocardium may disrupt normal electrical conduction pathways.

Correct. Negative T-waves in inferior ECG leads may indicate myocardial ischemia or repolarization abnormalities. These ECG changes can reflect regional myocardial dysfunction in the inferoposterior wall, which may predispose patients with MVP to ventricular arrhythmias and SCD. Negative T-waves in inferior leads may also be associated with concomitant coronary artery disease or myocardial fibrosis - therefore further increasing the risk of arrhythmias in patients with MVP.

Correct. PVCs are abnormal electrical impulses starting from the ventricles and occurring prematurely. Frequent PVCs can trigger ventricular arrhythmias, such as ventricular tachycardia and fibrillation, especially when occurring in a structurally abnormal heart like in MVP. PVCs may induce abnormal calcium handling and electrical remodeling - therefore leading to the development of reentrant circuits and malignant arrhythmias.

Correct. Bidirectional ventricular tachycardia is present in Andersen–Tawil syndrome Type 1. It is a distinctive ventricular arrhythmia where the QRS complexes alternate in direction, typically between positive and negative deflections. The mechanism of bidirectional ventricular tachycardia in Andersen–Tawil syndrome Type 1 is related to the potassium channel defect due to mutations in the KCNJ2 gene. This defect leads to abnormal repolarization and electrical instability in the ventricles - therefore resulting in bidirectional ventricular tachycardia.

Correct. Muscle weakness, especially periodic paralysis, is a characteristic symptom of Andersen–Tawil syndrome Type 1. Periodic paralysis is characterized by episodes of muscle weakness or paralysis that can occur spontaneously or be triggered by exercise, stress or changes in serum potassium levels. The mechanism of periodic paralysis is linked to potassium ion channel defect, which regulate muscle excitability and contractility. The defect is caused by mutations in the KCNJ2 gene.

Incorrect. Patients with the Andersen-Tawil syndrome may experience tachycardias (bidirectional ventricular tachycardia) but bradycardia is not a characteristic symptom of the syndrome.

Incorrect. Patients with the Andersen-Tawil syndrome may experience tachycardias (bidirectional ventricular tachycardia) but atrial fibrillation is not a characteristic symptom of the syndrome.

Incorrect. Antiarrhythmic drugs are commonly used to manage various cardiac arrhythmias, including ventricular tachycardia. However, in the case of inappropriate ICD shocks during electrical storm or incessant ventricular tachycardia, simple escalating antiarrhythmic drug therapy may not affect the cause of the shocks. These shocks could be answers to non-ventricular arrhythmias such as supraventricular tachycardias or lead-related issues - therefore disabling ICD therapies may be more appropriate.

Correct. Inappropriate ICD shocks can be caused by different factors, including SVTs or lead-related issues, which do not necessarily represent life-threatening arrhythmias. Disabling ICD therapies, such as shock delivery, is recommended to prevent unnecessary shocks and reduce patient discomfort. It allows for further evaluation and intervention as needed.

Incorrect. Inappropriate ICD shocks are typically not caused by insufficient energy levels of defibrillation shocks. Increasing the energy level of shocks may not address the underlying cause of the inappropriate shocks as the cause could be ICD response to SVTs or lead-related issues.

Correct. Analgosedation is recommended for comfort of the patient. However, the haemodynamic condition of the patient must be stable. Otherwise, advanced life support including defibrillation or external cardioversion should be performed in patients with haemodynamic instability. (Class I)

Correct. Sustained VT during pregnancy can be a significant risk to both the mother and the fetus due to impaired cardiac output and potential hemodynamic instability. Electrical cardioversion involves delivering a synchronized electrical shock to the heart during a specific phase of the cardiac cycle to restore normal sinus rhythm. This intervention terminates VT and prevents further complications or progression to more severe arrhythmias (ventricular fibrillation). (Class I)

Incorrect. Beta-blockers are reccommended for women with Long QT Syndrome (LQTS) or also with Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). Beta-blockers inhibit the beta-adrenergic receptors, which reduces sympathetic activity, heart rate, and contractility - therefore decreasing the risk of arrhythmia. (Class I)

Correct. For highly symptomatic recurrent SMVT during pregnancy, catheter ablation using non-fluoroscopic mapping systems should be considered after the first trimester. Non-fluoroscopic mapping systems use alternative imaging techniques like electroanatomic mapping or magnetic navigation to guide catheter placement and ablation without the need for continuous X-ray exposure - therefore reducing radiation exposure to the fetus.

Correct. Verapamil is a calcium channel blocker that inhibites the influx of calcium ions through voltage-gated calcium channels in cardiomyocytes. This leads to decreased myocardial contractility and conduction speed. During pregnancy, oral administration of verapamil should be considered for long-term management. Verapamil helps in controlling heart rate and rhythm - therefore reducing the frequency and severity of VT episodes.

Correct. Catheter ablation targets the site of origin of the PVCs to interrupt the arrhythmia circuit and prevent its recurrence. It is considered as an effective treatment for these patients.

Incorrect. Defibrillation is used to terminate ventricular arrhythmias. However, continuous external defibrillation therapy is not a practical approach for long-term management of patients with recurrent symptomatic episodes of PVT or VF triggered by similar premature ventricular contractions.

Incorrect. Pacemakers are primarily indicated for the management of bradyarrhythmias, not ventricular tachyarrhythmias.

Incorrect. Antiarrhythmic drugs are commonly used in the management of ventricular arrhythmias, but they may not be effective in patients with recurrent symptomatic episodes of PVT or VF triggered by similar PVCs.

Correct. Magnesium is an electrolyte involved in maintaining normal cardiac function. Hypomagnesemia can disrupt the electrical activity of the heart and can lead to prolongation of the QT interval, which is a risk factor for the development of ventricular arrhythmias such as Torsades de pointes (TdP). Administering intravenous magnesium is an effective therapy for TdP, even in cases where hypomagnesemia is not present.

Incorrect. Hypertension is a risk factor for cardiovascular disease, including coronary artery disease, heart failure, and stroke. However, it is not directly associated with ventricular arrhythmias in sudden cardiac arrest. Hypertension can be associated with other risk factors for sudden cardiac arrest, such as coronary artery disease and left ventricular dysfunction.

Incorrect. Hyperglycemia is characteristic for diabetes mellitus and metabolic syndrome. Diabetes and metabolic syndrome are risk factors for cardiovascular disease and may increase the risk of sudden cardiac arrest through mechanisms such as atherosclerosis and coronary artery disease, but hyperglycemia itself is not a direct cause of ventricular arrhythmias in sudden cardiac arrest. However, acute hyperglycemia can lead to electrolyte imbalances and metabolic disturbances, which may indirectly contribute to arrhythmia initiation in some patients.

Correct. Potassium is an essential electrolyte for maintaining normal cardiac function. It regulates the resting membrane potential, action potential duration, and repolarization phase of cardiac cells. Hypokalemia can disrupt the electrical activity of the heart, leading to ventricular arrhythmias.

Incorrect. Only beta-blockers have demonstrated a reduction in all-cause mortality in the context of managing ventricular arrhythmias.

Correct. Although, AADs are used as supportive therapy for VA, in patients with a history of recurrent ventricular tachycardia - Amiodarone can be used as first line therapy. They are also prescribed alongside other treatments, such as device therapy or lifestyle modifications, to manage symptoms and reduce the frequency of arrhythmias.

Incorrect. Some AADs may increase risks to patients with heart failure, but they are not always contraindicated. Administration of AADs in patients with heart failure should be based on assessment of the clinical status and the potential risks and benefits of treatment. For example - beta-blockers are used in heart failure management due to the ability to reduce heart rate, blood pressure, and the workload of the heart. Thus, beta-blockers can improve symptoms and outcomes in patients with heart failure.

Correct. AADs can prolong the QT interval, which increases the risk of developing torsades de pointes (TdP) and life-threatening ventricular arrhythmia. It is reccommended to monitor the QT interval when prescribing AADs and adjust doses or consider alternative medications if necessary to minimize this risk.

Incorrect. The trial does not conclude nor mention superiority in reducing mortality.

Correct. S-ICD lacks an intravasculary inserted intracardiac lead and therefore cannot deliver ATP.

Incorrect. The trial showed the rate of inappropriate shocks was 9.7 % in patients with S-ICD compared to 7.3 % in patients with conventional transvenous ICD.

Inorrect. The trial showed no significant difference in device-related complications between S-ICD and transvenous ICD.