Electrophysiological Study for VA Recommendations for Electrophysiological Study References that support the recommendations are summarized in Online Data Supplements 8 and 9. COR LOE Recommendations IIa B-R In patients with ischemic cardiomyopathy, NICM, or adult congenital heart disease who have syncope or other VA symptoms and who do not meet indications for a primary prevention ICD, an electrophysiological study can be useful for assessing the risk of III: No Benefit B-R In patients who meet criteria for ICD implantation, an electrophysiological study for the sole reason of inducing VA is not indicated for risk stratification.S4.3.2-8 S4.3.2-11 III: No Benefit B-NR An electrophysiological study is not recommended for risk stratification for VA in the setting of long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, or early Synopsis Electrophysiological study can be used to induce sus- tained VA in patients with known or suspected VA. With the advent of the ICD and its proven benefit in the pri- mary and secondary prevention of SCD, there are fewer indications for programmed stimulation to provoke VA. Patients with HF and LVEF 35% generally will have an indication for an ICD and specific induction of VT/VF before implantation is not necessary. Patients with LVEF >35% and unexplained syncope or near-syncope may benefit from an electrophysiological study to determine CLINICAL STATEMENTS AND GUIDELINES if VT/VF is the cause of symptoms and to guide further therapy. Induction of VT/VF is often attempted before catheter ablation of the arrhythmia substrate to guide the procedure and to determine the success of the in- tervention after ablation is performed. An electrophysi- ological study can be used to determine the mechanism of a wide complex tachycardia. See Sections 7.3, 7.4, electrophysiological study for specific disease states. Recommendation-Specific Supportive Text 1. 