Elevated levels of natriuretic peptides B-type natri- uretic peptide (BNP) or N-terminal pro-BNP are associated with increased risk of SCA and appro- priate ICD therapies, even after adjustment of LVEF and other risk factors.S4.2.5-1 S4.2.5-4 These biomarkers are also predictive of nonsudden cardiovascular mortality and thus are not specific to SCD risk alone. Natriuretic peptides have also been evaluated for predicting SCD in the general population.S4.2.5-5,S4.2.5-6 In the Nurses Health Study, an elevated N-terminal pro-BNP was an independent risk marker for SCD in presumably healthy women.S4.2.5-5 In an older adult population, higher baseline levels of N-terminal pro-BNP were associated with SCD over a 16-year These biomarkers may also have a potential role in facilitating the identifica- tion of individuals at increased risk of SCD and VA in the general population, particularly in those at intermediate or high risk of ischemic heart disease, but further studies are needed. Use of biomark- ers has not been shown to be useful for selecting patients for ICDs. A study of 4431 patients found high-sensitivity troponin to be only weakly predic- tive of SCD.S4.2.5-7 However, there are no data on whether high-sensitivity troponin can improve the current SCD prediction algorithms. 4.2.6. Genetic Considerations in Arrhythmia Syndromes Recommendation for Genetic Counselling* COR LOE Recommendation I C-EO In patients and family members in whom genetic testing for risk stratification for SCA or SCD is recommended, genetic counseling is beneficial. *Please refer to section 7.9 for disease-specific recommendations. Synopsis The diagnosis of most inherited arrhythmia syndromes is based on clinical features and family history. 