The majority of ERS are considered benign and do not require special treatment. However, malignant ventricular arrhythmias can occur in a small number of patients, and it is considered prudent to treat ERS patients with the following characteristics: 1) history of recurrent syncope; 2) survivors of sudden death; 3) family history of sudden death; and 4) abnormally large J waves. If syncope is confirmed to be associated with malignant ventricular arrhythmias and if the patient survives sudden death, an ICD should be implanted, and those with only the latter two features should be further evaluated and followed up.