Syncope is reported in 16% to 39% of arrhythmo- genic right ventricular cardiomyopathy patients at the time of diagnosis,S7.3-13,S7.3-14,S7.3-16,S7.3-41,S7.3-43 is frequently exercise-related, and has been associated with high arrhythmic risk in some Among patients with arrhyth- mogenic right ventricular cardiomyopathy and implanted ICDs, syncope was an important pre- dictor of appropriate shocks in 1 study,S7.3-10 but not in other studies.S7.3-9,S7.3-12,S7.3-13,S7.3-43 Studies have not provided information about ventricular function or abnormalities on ECG in patients with syncope, limiting its assessment as an indepen- dent risk factor. Syncope may be a harbinger of progression of underlying disease and should be integrated into the decision-making process for ICD implantation with the patient. 8. Asymptomatic patients with arrhythmogenic right ventricular cardiomyopathy and no VA or ventric- ular dysfunction are generally observed without antiarrhythmic therapy other than beta-blocker therapy, with ongoing periodic reassessment for the development of arrhythmias or ventricular Atenolol was shown to reduce VA in 1 study.S7.3-15 Ambulatory monitor- ing and/or exercise testing can be performed to assess adequacy of beta-blocking dosing. 9. Interrogation of ICDs shows that >90% of sponta- neous sustained VTs in arrhythmogenic right ven- tricular cardiomyopathy are monomorphic,S7.3-12 while sustained monomorphic VT is induc- ible at electrophysiological study in 55% of VT is usually related to scar-related reentry, and the subepicardium usually has more extensive scar than the endocardium.S7.3-27 In experienced centers, use of epicardial map- ping and ablation is associated with better Important complications including pericardial tamponade, MI, and death occur in 2.3% to 3.3% of abla- emphasizing the need for performance in centers with specialized expertise in epicardial procedures. Ablation reduces the fre- quency of recurrent VT, although 27% to 55% have at least 1 recurrence; ablation of VT in arrhythmogenic right ventricular cardiomyopathy patients does not eliminate the need for an ICD in appropriate candidates. 