1 FOCUS ARTICLE EuroIntervention 2014;10-online publish-ahead-of-print August 2014 DOI: 10.4244/EIJY14M08_19 * Corresponding author: Prof. Bulent Gorenek MD FACC FESC, Eskisehir Osmangazi University Cardiology Department, Eskisehir, Turkey. Tel: +90 222 2292266; Fax: +90 222 2292266. E-mail: bulent@gorenek.com † EHRA. ‡ ACCA. ¶ EAPCI. Developed in partnership with the European Heart Rhythm Association (EHRA), the Acute Cardio- vascular Care Association (ACCA), and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). The article has been co-published with permission in EP-Europace, European Heart Journal - Acute Cardiovascular Care and EuroIntervention. All rights reserved in respect of European Heart Journal - Acute Cardiovascular Care and EuroIntervention. © The Authors 2014. For EP-Europace, © The Author 2014. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force Bulent Gorenek* † (Chairperson, Turkey), Carina Blomström Lundqvist † (Sweden), Josep Brugada Terradellas † (Spain), A. John Camm † (UK), Gerhard Hindricks † (Germany), Kurt Huber ‡ (Austria), Paulus Kirchhof † (UK), Karl-Heinz Kuck † (Germany), Gulmira Kudaiberdieva † (Turkey), Tina Lin † (Germany), Antonio Raviele † (Italy), Massimo Santini † (Italy), Roland Richard Tilz † (Germany), Marco Valgimigli ¶ (The Netherlands), Marc A. Vos † (The Netherlands), Christian Vrints ‡ (Belgium), and Uwe Zeymer ‡ (Germany) Document Reviewers: Gregory Y.H. Lip (Review Coordinator) (UK), Tatjania Potpara (Serbia), Laurent Fauchier (France), Christian Sticherling (Switzerland), Marco Roffi (Switzerland), Petr Widimsky (Czech Republic), Julinda Mehilli (Germany), Maddalena Lettino (Italy), Francois Schiele (France), Peter Sinnaeve (Belgium), Giueseppe Boriani (Italy), Deirdre Lane (UK), and Irene Savelieva (on behalf of EP-Europace, UK) Introduction It is known that myocardial ischaemia and infarction leads to severe metabolic and electrophysiological changes that induce silent or symptomatic life-threatening arrhythmias. Sudden cardiac death is most often attributed to this pathophysiology, but many patients sur- vive the early stage of an acute coronary syndrome (ACS) reaching a medical facility where the management of ischaemia and infarc- tion must include continuous electrocardiographic (ECG) and hemo- dynamic monitoring, and a prompt therapeutic response to incident sustained arrhythmias. During the last decade, the hospital locations in which arrhythmias are most relevant have changed to include the cardiac catheterization laboratory, since the preferred management of early acute ACS is generally interventional in nature. However, a large proportion of patients are still managed medically. Both atrial and ventricular arrhythmias may occur in the set- ting of ACS and sustained ventricular tachyarrhythmias (VAs) may be associated with circulatory collapse and require immediate treatment. Atrial fibrillation (AF) may also warrant urgent treat- ment when a fast ventricular rate is associated with hemodynamic deterioration. The management of other arrhythmias is also based largely on symptoms rather than to avert progression to more seri- ous arrhythmias. Prophylactic antiarrhythmic management strate- gies have largely been discouraged. Although the mainstay of antiarrhythmic therapy used to rely on antiarrhythmic drugs (AADs), particularly sodium channel blockers and amiodarone, their use has now declined, since clinical evidence to support such treatment has never been convincing. Therapy for acute coronary syndrome and arrhythmia management are now based increasingly on invasive approaches. The changes in the clinical approach to arrhythmia management in ACS have been so substantial that the European Heart Rhythm Association, the Acute Cardiovascular Care Association and the European Association of Percutaneous Cardiovascular Interventions established a task force to define the current position.