Conclusion.
A substantial proportion of adults under the age of 60 who present with
ventricular tachyarrhythmia requiring an ICD will not have an apparent
diagnosis after baseline ECG, TTE and coronary assessment. Comprehensive
assessment with second-line investigations such as CMR, flecainide
challenge and genetic testing may provide an underlying diagnosis in
many of these patients, however the diagnostic evaluation in these
patients is highly variable and often incomplete. Implementation of a
systematic protocol for work-up of these patients requires further
study.