Catecholaminergic Polymorphic Ventricular Tachycardia Recommendations for Catecholaminergic Polymorphic Ventricular Tachycardia References that support the recommendations are summarized in Online Data Supplement 41. COR LOE Recommendations I B-NR In patients with catecholaminergic polymorphic ventricular tachycardia, a beta blocker is recommended.S7.9.1.2-1,S7.9.1.2-2 I B-NR In patients with catecholaminergic polymorphic ventricular tachycardia and recurrent sustained VT or syncope, while receiving adequate or maximally tolerated beta blocker, treatment intensification with either combination medication therapy (eg, beta blocker, flecainide), left cardiac sympathetic denervation, and/or an ICD is IIa B-NR In patients with catecholaminergic polymorphic ventricular tachycardia and with clinical VT or exertional syncope, genetic counseling and genetic testing are Recommendation-Specific Supportive Text 1. Catecholaminergic polymorphic ventricular tachy- cardia is characterized by exertion-related poly- morphic or bidirectional VT (Figure 13), associated with syncope and SCA. SCA/SCD is reported Treatment with beta blockers is associated with a reduction in adverse cardiac events.S7.9.1.2-1,S7.9.1.2-2 Some experts prefer the use of nadolol over other types of beta blockers; direct comparison data among beta blockers are unavailable. Use of a maximally tolerated dose of a beta blocker is important. Small observational studies sug- gest possible benefit of nondihydropyridine calcium channel blockers in the treatment of catecholaminergic polymorphic ventricular 2. Flecainide in combination with a beta blocker can suppress ventricular ectopy by as much as 76% in patients with catecholaminergic poly- morphic ventricular tachycardia during exercise testing or clinical follow-up.S7.9.1.2-2,S7.9.1.2-6,S7.9.1.2-11 For refractory VA, verapamil or propafenone may also be effective.S7.9.1.2-9,S7.9.1.2-10,S7.9.1.2-12 ICD implantation in patients with catecholaminergic polymorphic ventricular tachycardia should be reserved for patients with prior SCA, or patients with refractory VAs on combination medical therapy. 