Clinical management of ventricular tachycardia

Curr Probl Cardiol. 2010 Sep;35(9):453-504. doi: 10.1016/j.cpcardiol.2010.08.001.

Abstract

Ventricular tachycardia (VT) may be monomorphic or polymorphic. Although commonly related to organic heart disease, a significant percentage of VTs are idiopathic (occurring in patients with otherwise normal hearts). Correctly identifying the substrate and mechanism of the tachycardia is essential for proper management. Although therapy for monomorphic VT associated with structural heart disease focuses on tachycardia suppression and reduction of sudden cardiac death (SCD) risk, idiopathic monomorphic VT generally does not entail an increased risk of SCD and treatment is aimed primarily at symptom reduction. Polymorphic VT associated with ischemia or an acquired precipitant that prolongs the QT interval should prompt reversal of underlying cause, in contrast to the congenital arrhythmia syndromes, which demand genetic testing to define the underlying problem. This review describes the diagnosis, mechanisms, etiology, and management of monomorphic and polymorphic VT, with attention to recent advances in biological understanding and the most current therapeutic recommendations.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / adverse effects
  • Anti-Arrhythmia Agents* / administration & dosage
  • Anti-Arrhythmia Agents* / adverse effects
  • Brugada Syndrome / complications
  • Brugada Syndrome / genetics
  • Calcium Channel Blockers / administration & dosage
  • Calcium Channel Blockers / adverse effects
  • Catheter Ablation
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators
  • Drug Administration Routes
  • Electric Countershock / instrumentation
  • Electrocardiography*
  • Genetic Predisposition to Disease
  • Heart Conduction System / drug effects
  • Heart Conduction System / physiopathology
  • Humans
  • Long QT Syndrome / complications
  • Long QT Syndrome / genetics
  • Myocardial Ischemia / complications
  • Sodium Channel Blockers / administration & dosage
  • Sodium Channel Blockers / adverse effects
  • Tachycardia, Ventricular / complications
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / genetics
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / physiopathology
  • Tachycardia, Ventricular / therapy*

Substances

  • Adrenergic beta-Antagonists
  • Anti-Arrhythmia Agents
  • Calcium Channel Blockers
  • Sodium Channel Blockers