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VA in the presence of structural heart disease (SHD) has distinct prognostic implications and requires a comprehensive and multifaceted approach for investigation and management. Early specialist referral should be considered for all patients with VA. Particular urgency is recommended in patients with syncope, nonsustained\/sustained VA on Holter monitor and SHD on cardiac imaging because of\u00a0the heightened risk of sudden cardiac death. Comprehensive phenotyping is recommended for most patients with VA, encompassing noninvasive cardiac functional testing, multimodality imaging and genetic testing in select circumstances. Management of idiopathic VA is guided heavily by symptom burden and the presence of ventricular systolic impairment. In SHD, guideline\u2010directed heart failure therapy and device implantation are critical considerations. Whilst commonly used and well\u2010established, antiarrhythmic drugs can be hampered by toxicity and failure of adequate arrhythmia control. Catheter ablation is increasingly being considered a feasible first\u2010line alternative to medical therapy, where outcomes are influenced by disease aetiology and scar burden in SHD. Catheter ablation is associated with reduced arrhythmia recurrence and burden and improved quality of life at follow\u2010up.<\/jats:p>","DOI":"10.1111\/imj.15976","type":"journal-article","created":{"date-parts":[[2022,11,12]],"date-time":"2022-11-12T03:03:42Z","timestamp":1668222222000},"page":"892-906","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Contemporary updates on ventricular arrhythmias: from mechanisms to management"],"prefix":"10.1111","volume":"53","author":[{"given":"Ashwin","family":"Bhaskaran","sequence":"first","affiliation":[{"name":"Department of Cardiology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Applied Research Centre University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasun","family":"De Silva","sequence":"additional","affiliation":[{"name":"Department of Cardiology Westmead Hospital  Sydney 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