{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:03:55Z","timestamp":1764785035639,"version":"3.37.3"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T00:00:00Z","timestamp":1677369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The diagnostic work\u2010up for cardiac arrest from ventricular tachyarrhythmias occurring in younger adults and structurally normal hearts is variable and often incomplete.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed records for all recipients of a secondary prevention implantable cardiac defibrillator (ICD) younger than 60 years at a single quaternary referral hospital from 2010 to 2021. Patients with unexplained ventricular arrhythmias (UVA) were identified as those with no structural heart disease on echocardiogram, no obstructive coronary disease, and no clear diagnostic features on ECG. We specifically evaluated the adoption rate of five modalities of \u201csecond\u2010line\u201d\u00a0cardiac investigations: cardiac magnetic resonance imaging (CMR), exercise ECG, flecainide challenge, electrophysiology study (EPS), and genetic testing. We also evaluated patterns of antiarrhythmic drug therapy and device\u2010detected arrhythmias and compared them with secondary prevention ICD recipients with a clear etiology found on initial assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and two recipients of a secondary prevention ICD under the age of 60 were analyzed. Thirty\u2010nine patients (38.2%) were identified with UVA and were compared with the remaining 63 patients with VA of clear etiology (61.8%). UVA patients were younger (35.6\u2009\u00b1\u200913.0\u00a0vs. 46.0\u2009\u00b1\u20098.6 years, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and were more often female (48.7% vs. 28.6%, <jats:italic>p<\/jats:italic>\u2009=\u2009.04). CMR was performed in 32 patients with UVA (82.1%), whereas flecainide challenge, stress ECG, genetic testing, and EPS were only performed in a minority of patients. Overall, the use of a second\u2010line investigation suggested an etiology in 17 patients with UVA (43.5%). Compared to patients with VA of clear etiology, UVA patients had lower rates of antiarrhythmic drug prescription (64.1% vs. 88.9%, <jats:italic>p<\/jats:italic>\u2009=\u2009.003) and had a higher rate of device\u2010delivered tachy\u2010therapies (30.8% vs. 14.3%, <jats:italic>p<\/jats:italic>\u2009=\u2009.045).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this real\u2010world analysis of patients with UVA, the diagnostic work\u2010up is often incomplete. While CMR was increasingly utilized at our institution, investigations for channelopathies and genetic causes appear to be underutilized. Implementation of a systematic protocol for work\u2010up of these patients requires further study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15868","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T23:06:02Z","timestamp":1676675162000},"page":"959-966","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic evaluation of unexplained ventricular tachyarrhythmias in younger adults"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7482-211X","authenticated-orcid":false,"given":"Jeremy","family":"William","sequence":"first","affiliation":[{"name":"The Alfred Hospital  Melbourne Australia"},{"name":"Central Clinical School Monash University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoman","family":"Xiao","sequence":"additional","affiliation":[{"name":"The Alfred Hospital  Melbourne 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