VA IN THE STRUCTURALLY NORMAL HEART Recommendations for VA in the Structurally Normal Heart References that support the recommendations are summarized in Online Data Supplement 45. COR LOE Recommendations I B-R In patients with symptomatic PVCs in an otherwise normal heart, treatment with a beta blocker or nondihydropyradine calcium channel blocker is useful to reduce recurrent arrhythmias and improve IIa B-R In patients with symptomatic VA in an otherwise normal heart, treatment with an antiarrhythmic medication is reasonable to reduce recurrent symptomatic arrhythmias and improve symptoms if beta blockers and nondihydropyradine calcium channel blockers are ineffective or Synopsis Most idiopathic VA are due to a focal mechanism of triggered activity or abnormal automaticity, some, no- tably interfascicular reentrant LV tachycardias, are due to reentry. The clinical manifestations of idiopathic VA are highly variable and range from benign, asymptom- atic PVCs to sustained VT or even VF. On initial discovery, an evaluation for structural heart disease is warranted with physical examination, an ECG, and imaging, usu- ally with echocardiography. In the absence of any ab- normality or a family history of SCD, further assessment and treatment are guided by symptoms. If the patient is asymptomatic and does not have evidence of a cardiac channelopathy, reassurance as to the benign nature is sufficient. If the arrhythmia is suspected of being suf- ficiently frequent to cause ventricular dysfunction over time, periodic follow-up with reassessment of ventricular function is warranted (see Section 10.8). For mild symp- toms, avoidance of aggravating factors such as excessive consumption of caffeine or sympathomimetic agents, may be sufficient. Therapy with a beta blocker or non- dihydropyradine calcium channel blocker reduces symp- toms for some patients. Class I antiarrhythmic medica- tions can be effective, but those are generally avoided due to concerns for adverse effects. 