History

Fact Explanation
History of previous MI Cardiac arrhythmias are produced by one of three mechanisms which are enhanced automaticity, triggered activity, or reentry. When an impulse doesn't die after propagation and when it continues to excite the heart even when the refractory period ended causes re-entry induced arrhythmia . Atrial fibrillation, atrial flutter, atrioventricular (AV) nodal reentry, ventricular tachycardia after myocardial infarction (MI) and ventricular fibrillation are common arrhythmias which are produced by this mechanism. Atrioventricular reentrant tachycardia (AVRT) is a reentrant tachycardia which results due to having 2 pathways one being normal and the other one being an accessory pathway. Atrioventricular node re-entrant tachycardia (AVNRT) caused by re-entry within the the atrioventricular (AV) node. [1] [2] [8]
Feeding problems, Irritability, Increased sweating in an infant [2] These symptoms suggestive of congestive cardiac failure in an infant because tachy-arrhythmia in an infant can cause heart failure. [2]
Palpitations [3] [7] Sensation of pounding of the heart is due to abnormal rhythm [3] [7]
Light-headedness/ Syncope [3] [7] Due to cerebral hypo-perfusion due to extreme tachycardia [4] [7]
Chest pain [3] [7] Can be due to ischaemia or palpitations it self [3] [7]
Anxiety [3] [7] Due to palpitations [3] [7]
Sudden death [4] [6] [7] catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disease causing episodes of syncope, seizures, or sudden death [4] [6] [7]
References
  1. DE BAKKER J. M., VAN CAPELLE F. J., JANSE M. J., WILDE A. A., CORONEL R., BECKER A. E., DINGEMANS K. P., VAN HEMEL N. M., HAUER R. N.. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation [online] 1988 March, 77(3):589-606 [viewed 09 July 2014] Available from: doi:10.1161/​01.CIR.77.3.589
  2. WU D., AMAT-Y-LEON F., DENES P., DHINGRA R. C., PIETRAS R. J., ROSEN K. M.. Demonstration of sustained sinus and atrial re-entry as a mechanism of paroxysmal supraventricular tachycardia. Circulation [online] 1975 February, 51(2):234-243 [viewed 09 July 2014] Available from: doi:10.1161/​01.CIR.51.2.234
  3. KOLETTIS THEOFILOS M.. Ventricular tachyarrhythmias during acute myocardial infarction: The role of endothelin-1. Life Sciences [online] 2014 January [viewed 09 July 2014] Available from: doi:10.1016/j.lfs.2014.01.060
  4. NOVAK A, BARAD L, LORBER A, ITSKOVITZ-ELDOR J, BINAH O. Modeling Catecholaminergic Polymorphic Ventricular Tachycardia using Induced Pluripotent Stem Cell-derived Cardiomyocytes Rambam Maimonides Med J [online] , 3(3):e0015 [viewed 09 July 2014] Available from: doi:10.5041/RMMJ.10086
  5. KATRITSIS D. Nonsustained ventricular tachycardia: where do we stand?. European Heart Journal [online] 2004 July, 25(13):1093-1099 [viewed 09 July 2014] Available from: doi:10.1016/j.ehj.2004.03.022
  6. MIYAKE C. Y., WEBSTER G., CZOSEK R. J., KANTOCH M. J., DUBIN A. M., AVASARALA K., ATALLAH J.. Efficacy of Implantable Cardioverter Defibrillators in Young Patients With Catecholaminergic Polymorphic Ventricular Tachycardia: Success Depends on Substrate. Circulation: Arrhythmia and Electrophysiology [online] December, 6(3):579-587 [viewed 09 July 2014] Available from: doi:10.1161/CIRCEP.113.000170
  7. SCHEINMAN MM, MORADY F, SHEN EN, BHANDARI A, SCHWARTZ AB. Clinical Symptoms in Patients With Sustained Ventricular Tachycardia West J Med [online] 1985 Mar, 142(3):341-344 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306023
  8. WEISS J. N.. The Dynamics of Cardiac Fibrillation. Circulation [online] 2005 August, 112(8):1232-1240 [viewed 09 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.104.529545

Examination

Fact Explanation
Tachycardia [1] [2] [3] When caused by electrical reentry or abnormal automaticity and this results in tachycardia [1] [2] [3]
Hypotension [3] Sometimes patients may present with haemodynamic instability due to prolonged arrhythmia, particularly tachycardia, and this could result in hypotension [3]
Tachypnoea [3] Sometimes patients may present with haemodynamic instability due to prolonged arrhythmia, particularly tachycardia and this could result in increased respiratory rate [3]
Diaphoresis [3] Sometimes patients may present with haemodynamic instability due to prolonged arrhythmia, particularly tachycardia and reduced cardiac output due to tachycardia result in poor perfusion and resultant increased sweating [3]
Pallor [3] Sometimes patients may present with haemodynamic instability due to prolonged arrhythmia, particularly tachycardia and reduced cardiac output due to tachycardia result in poor perfusion and pallor [3]
Diminished level of consciousness [3] Sometimes patients may present with haemodynamic instability due to prolonged arrhythmia, particularly tachycardia and reduced cardiac output due to tachycardia result in poor perfusion to brain and diminished level of consciousness [3]
Elevated jugular venous pressure with cannon a waves [4] [5] This is only observed if sinus rhythm is preserved in atria [4] [5]
Murmers [7] If the underlying pathology for arrhythmia is valvular diseases murmurs may be heard. [7] [7]
Displaced apex [7] Due to cardiomegaly due to underlying ischaemic heart disease [7]
Rales on respiratory system examination If the arrhythmia leads to congestive cardiac failure, auscultation of lungs may reveal rales [7]
Varying intensity of the first heart sound [6] Due to asynchrony of atria and ventricles. [6]
References
  1. KATRITSIS D. Nonsustained ventricular tachycardia: where do we stand?. European Heart Journal [online] 2004 July, 25(13):1093-1099 [viewed 09 July 2014] Available from: doi:10.1016/j.ehj.2004.03.022
  2. SCHEINMAN MM, MORADY F, SHEN EN, BHANDARI A, SCHWARTZ AB. Clinical Symptoms in Patients With Sustained Ventricular Tachycardia West J Med [online] 1985 Mar, 142(3):341-344 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306023
  3. CHUNG HH, KIM JB, HONG SH, LEE HJ, JOUNG B, LEE MH. Radiofrequency Catheter Ablation of Hemodynamically Unstable Ventricular Tachycardia Associated with Systemic Sclerosis J Korean Med Sci [online] 2012 Feb, 27(2):215-217 [viewed 09 July 2014] Available from: doi:10.3346/jkms.2012.27.2.215
  4. HANASH CR, CROSSON JE. Emergency diagnosis and management of pediatric arrhythmias J Emerg Trauma Shock [online] 2010, 3(3):251-260 [viewed 09 July 2014] Available from: doi:10.4103/0974-2700.66525
  5. CHEN D., PAI P.-Y.. Cannon A Wave. Circulation [online] 2009 April, 119(13):e381-e383 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.108.833095
  6. FELNER JM, WALKER HK, HALL WD, HURST JW. The First Heart Sound [online] 1990 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21250175
  7. GARRATT C. J., GRIFFITH M. J., YOUNG G., CURZEN N., BRECKER S., RICKARDS A. F., CAMM A. J.. Value of physical signs in the diagnosis of ventricular tachycardia. Circulation [online] 1994 December, 90(6):3103-3107 [viewed 09 July 2014] Available from: doi:10.1161/01.CIR.90.6.3103

Differential Diagnoses

Fact Explanation
Atrial Fibrillation [1] This is the most common arrhythmia, and can lead to heart failure, stroke, and death and this can mimic ventricular tachycardia [1]
Atrial Flutter [2] This produces a sawtooth pattern on the electrocardiogram and some what similar to atrial fibrillation. It may mimic VT [2]
Ventricular Fibrillation [3] There's disorganization of atria and ventricles and the resultant electrocardiogram is very irregular broad complex tachycardia. This is a life threatening arrhythmia [3]
Pacemaker induced tachycardia [4] Arrhythmias may be produced by pacemakers sometimes. Ex: atrial flutter or atrial fibrillation. [4]
Wolff-Parkinson-White syndrome [5] There's an accessory pathway between the atria and ventricles and the clinical symptoms mimic Ventricular tachycardia [5]
Accelerated idioventricular rhythm [6] This rhythm is slower than Ventricular tachycardia and is considered as a good electrocardiographic change which clinicians like to observe after successful thrombolysis. [6]
Supraventricular tachycardia with abberant conduction [7] This produces a broad complex tachycardia in the electrocardiogram. [7]
long QT syndrome [8] QT interval is long in the electrocardiogram with torsade de pointes arrhythmias are observed. It has a high risk for sudden cardiac death [8]
References
  1. ROBERTS JD, GOLLOB MH. A Contemporary Review on the Genetic Basis of Atrial Fibrillation Methodist Debakey Cardiovasc J [online] 2014, 10(1):18-24 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051329
  2. FOY S, LEVIS JT. ECG Diagnosis: Type I Atrial Flutter Perm J [online] 2014, 18(2):e128 [viewed 09 July 2014] Available from: doi:10.7812/TPP/13-132
  3. KIM SH, KIM DH, PARK SD, BAEK YS, WOO SI, SHIN SH, KWAN J, PARK KS. The Relationship Between J Wave on the Surface Electrocardiography and Ventricular Fibrillation during Acute Myocardial Infarction J Korean Med Sci [online] 2014 May, 29(5):685-690 [viewed 09 July 2014] Available from: doi:10.3346/jkms.2014.29.5.685
  4. DABROWSKA-KUGACKA ALICJA, LEWICKA-NOWAK EWA, RUCINSKI PIOTR, KOZLOWSKI DARIUSZ, RACZAK GRZEGORZ, KUTARSKI ANDRZEJ. Single-Site Bachmann's Bundle Pacing Is Beneficial While Coronary Sinus Pacing Results in Echocardiographic Right Heart Pacemaker Syndrome in Brady-Tachycardia Patients. Circ J [online] 2010 December, 74(7):1308-1315 [viewed 09 July 2014] Available from: doi:10.1253/circj.CJ-09-0846
  5. SVENDSEN J. H., DAGRES N., DOBREANU D., BONGIORNI M. G., MARINSKIS G., BLOMSTROM-LUNDQVIST C.. Current strategy for treatment of patients with Wolff-Parkinson-White syndrome and asymptomatic preexcitation in Europe: European Heart Rhythm Association survey. Europace [online] December, 15(5):750-753 [viewed 09 July 2014] Available from: doi:10.1093/europace/eut094
  6. ORNEK E, DURAN M, DEMIRçELIK BM, MURAT S, KURTUL A, ÇIçEKçIOGLU H, ÇETIN M, KAHVECI K, DOGER C, ÇETIN Z, ORNEK D. The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias. Niger J Clin Pract [online] 2014 December [viewed 09 July 2014] Available from: doi:10.4103/1119-3077.127545
  7. WANG P. J.. Supraventricular Tachycardia. [online] 2002 December, 106(25):206e-208 [viewed 09 July 2014] Available from: doi:10.1161/01.CIR.0000044341.43780.C7
  8. ANTZELEVITCH C. Sympathetic modulation of the long QT syndrome. European Heart Journal [online] 2002 August, 23(16):1246-1252 [viewed 09 July 2014] Available from: doi:10.1053/euhj.2002.3287

Investigations - for Diagnosis

Fact Explanation
Electrocardiography (ECG [1] This is important to diagnose the specific arrhythmia which could be atrial fibrillation, atrial flutter, atrioventricular (AV) nodal reentry, ventricular tachycardia or ventricular fibrillation [1] [8]
Echocardiography [2] Echocardiography could be helpful to show any valvular defects, hypokinetic segments suggestive of previous MI, chamber size and function and ejection fraction. [2]
Cardiac imaging studies [3] [6] When echocardiography results are inconclusive, to detect structural heart diseases this is done [3] [6]
Monitoring devices [4] [5] Halter monitoring, implantation of a loop recorder are monitoring devices used to assess patients with history of syncope but when the resting ECG is normal [4] [5]
Myocardial biopsy [6] This could be important to diagnose hypertrophic cardiomyopathy, arrhythmogenic right ventricular disease or sarcoidosis, amyloidosis [6]
Electrophysiological studies (EPS) [7] When a patient has a history of myocardial infarction, or has clinical symptoms of VT rarely these tests are done [7]
References
  1. 1) ALZAND B. S. N., CRIJNS H. J. G. M.. Diagnostic criteria of broad QRS complex tachycardia: decades of evolution. Europace [online] December, 13(4):465-472 [viewed 09 July 2014] Available from: doi:10.1093/europace/euq430
  2. 5) CHONG JAMES J. H, et al. Human embryonic-stem-cell-derived cardiomyocytes regenerate non-human primate hearts. Nature [online] December, 510(7504):273-277 [viewed 09 July 2014] Available from: doi:10.1038/nature13233
  3. 6) HOEY EDWARD T. D., GULATI GURPREET SINGH, GANESHAN ARUL, WATKIN RICHARD W., SIMPSON HELEN, SHARMA SANJIV. Cardiovascular MRI for Assessment of Infectious and Inflammatory Conditions of the Heart. American Journal of Roentgenology [online] 2011 July, 197(1):103-112 [viewed 09 July 2014] Available from: doi:10.2214/AJR.10.5666
  4. 7) CANTILLON D. J.. Evaluation and management of premature ventricular complexes. Cleveland Clinic Journal of Medicine [online] December, 80(6):377-387 [viewed 09 July 2014] Available from: doi:10.3949/ccjm.80a.12168
  5. 8) ZIMETBAUM P., GOLDMAN A.. Ambulatory Arrhythmia Monitoring: Choosing the Right Device. Circulation [online] December, 122(16):1629-1636 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.109.925610
  6. 9) COELHO-FILHO O. R., MONGEON F.-P., MITCHELL R. N., BLANKSTEIN R., JEROSCH-HEROLD M., KWONG R. Y.. Loffler Endocarditis Presenting With Recurrent Polymorphic Ventricular Tachycardia Diagnosed by Cardiac Magnetic Resonance Imaging. Circulation [online] December, 122(1):96-99 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.110.944538
  7. 10) KOLANDAIVELU ARAVINDAN, LARDO ALBERT C, HALPERIN HENRY R. Cardiovascular magnetic resonance guided electrophysiology studies. Array [online] 2009 December [viewed 09 July 2014] Available from: doi:10.1186/1532-429X-11-21
  8. DE BAKKER J. M., VAN CAPELLE F. J., JANSE M. J., WILDE A. A., CORONEL R., BECKER A. E., DINGEMANS K. P., VAN HEMEL N. M., HAUER R. N.. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation [online] 1988 March, 77(3):589-606 [viewed 09 July 2014] Available from: doi:10.1161/​01.CIR.77.3.589

Investigations - Fitness for Management

Fact Explanation
Venography [1] Obstruction of the access vein is a known complication of both permanent pacemaker and implantable cardioverter defibrillation implantation, therefore this could be done prior to implantation [1]
Renal function tests including estimated glomerular filteration rate, serum creatinine, blood urea nitrogen [2] [3] To assess fitness for anesthesia [2]
Full blood count [3] To exclude anaemia prior to any caridac surgery. [3]
Coagulation studies [3] To exclude any coagulopathy prior to any cardiac surgery. [3]
References
  1. HAGHJOO M., NIKOO M. H., FAZELIFAR A. F., ALIZADEH A., EMKANJOO Z., SADR-AMELI M. A.. Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade. Europace [online] 2007 March, 9(5):328-332 [viewed 09 July 2014] Available from: doi:10.1093/europace/eum019
  2. SCHEFER T., WOLBER T., BINGGELI C., HOLZMEISTER J., BRUNCKHORST C., DURU F.. Long-term predictors of mortality in ICD patients with non-ischaemic cardiac disease: impact of renal function. Europace [online] 2008 August, 10(9):1052-1059 [viewed 09 July 2014] Available from: doi:10.1093/europace/eun186
  3. CORNELISSEN H.. Preoperative assessment for cardiac surgery. Continuing Education in Anaesthesia, Critical Care & Pain [online] 2006 June, 6(3):109-113 [viewed 09 July 2014] Available from: doi:10.1093/bjaceaccp/mkl013

Investigations - Followup

Fact Explanation
Electrocardiography (ECG) [1] To assess for development of any other life threatening arrhythmias such as ventricular fibrillation, and to see the arrhythmias induced by drug therapy. [1]
Echocardiography [2] To assess for ejection fraction, for the possibility of congestive cardiac failure as consequence later [2]
Liver function tests [3] To see any amiodarone induced liver damage with long term amiodarone therapy [3]
Chest x ray [3] To see any amiodarone induced lung changes with long term amiodarone therapy [3]
Thyroid profile [3] To see any amiodarone induced hyper/hypothyroidism with long term amiodarone therapy [3]
References
  1. KATRITSIS D. Nonsustained ventricular tachycardia: where do we stand?. European Heart Journal [online] 2004 July, 25(13):1093-1099 [viewed 09 July 2014] Available from: doi:10.1016/j.ehj.2004.03.022
  2. TUNG R., BOYLE N. G., SHIVKUMAR K.. Catheter Ablation of Ventricular Tachycardia. Circulation [online] December, 122(3):e389-e391 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.110.963371
  3. CONNOLLY S. J.. Evidence-Based Analysis of Amiodarone Efficacy and Safety. Circulation [online] 1999 November, 100(19):2025-2034 [viewed 09 July 2014] Available from: doi:10.1161/01.CIR.100.19.2025

Investigations - Screening/Staging

Fact Explanation
Genetic testing for familial disorders [2] [3] Long QT syndrome, ARVD, or dilated or hypertrophic cardiomyopathy, Catecholaminergic Polymorphic Ventricular Tachycardia have inherited etiologies therefore, genetic testing is done. [2] [3]
Electrocardiography [1] To see any features of long QT syndrome, Brugada syndrome in an asymptomatic patient who has a family history of VT or sudden death [1]
Echocardiography [4] To carry out screening in families who might be affected with hypertrophic obstructive cardiomyopathy or dilated cardiomyopathy which may lead to VT [4]
Treadmill testing [1] To see any features of exercise induced long QT syndrome, in an asymptomatic patient who has a family history of VT or sudden death [1]
References
  1. OBEYESEKERE M. N., KLEIN G. J., MODI S., LEONG-SIT P., GULA L. J., YEE R., SKANES A. C., KRAHN A. D.. How to Perform and Interpret Provocative Testing for the Diagnosis of Brugada Syndrome, Long-QT Syndrome, and Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation: Arrhythmia and Electrophysiology [online] December, 4(6):958-964 [viewed 09 July 2014] Available from: doi:10.1161/CIRCEP.111.965947
  2. LAHAT H.. RYR2 and CASQ2 Mutations in Patients Suffering From Catecholaminergic Polymorphic Ventricular Tachycardia * Response. [online] 2003 January, 107(3):29e-29 [viewed 09 July 2014] Available from: doi:10.1161/01.CIR.0000050555.40735.ED
  3. SY R. W., KRAHN A. D.. Exercise testing: the catecholaminergic polymorphic ventricular tachycardia crystal ball?. Europace [online] December, 14(9):1225-1227 [viewed 09 July 2014] Available from: doi:10.1093/europace/eus146
  4. STRICKBERGER S. A.. AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: In Collaboration With the Heart Rhythm Society: Endorsed by the American Autonomic Society. Circulation [online] 2006 January, 113(2):316-327 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.105.170274

Management - General Measures

Fact Explanation
Acute management of ventricular tachycardia in an unstable patient. [1] [2] [3] Synchronized direct current (DC) cardioversion is used in patients with unstable monomorphic VT and unstable polymorphic VT is treated with immediate defibrillation[1]
Acute management with drugs in a stable patient with ventricular tachycardia [1] [2] [3] Intravenous (IV) procainamide, sotalol, Lidocaine is used in a stable patient [1]
Initial management in a hemodynamically stable patient with supraventricular tachycardia with vagal maneuvers [4] Vagal maneuvers such as placing an ice bag to the face, which is considered effective in infants, Valsalva maneuver in adults are done. Carotid sinus massage is also effective. These result in reduction of tachycardia with vagal stimulation [4]
Initial pharmacological therapy in a stable patient with supraventricular tachycardia [5] Adenosine is the first-line agent with Procainamide and esmolol for resistant cases [5]
Dietary management [6] low-cholesterol diets, low-salt diets, or both are recommended for patients with VT. Avoidance of caffeine which is a stimulant is also advised. [6]
Activity [7] Increased sympathetic tone during strenuous physical exertion can stimulate a VT. Therefore it's better avoided [7]
Patient education [8] patient education regarding nature, course, prognosis of disease, the precautions after starting anti arrhythmic therapy, or ICD implantation is needed. [8]
Patient identification [8] When a patient presents with syncope, cardiac arrest, patient identification with a bracelet/ diagnosis card is helpful for further management [8]
References
  1. HANASH CR, CROSSON JE. Emergency diagnosis and management of pediatric arrhythmias J Emerg Trauma Shock [online] 2010, 3(3):251-260 [viewed 09 July 2014] Available from: doi:10.4103/0974-2700.66525
  2. Part 7.3: Management of Symptomatic Bradycardia and Tachycardia. Circulation [online] 2005 November, 112(24_suppl):IV-67-IV-77 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.105.166558
  3. TRAPPE HJ. Concept of the five 'A's for treating emergency arrhythmias J Emerg Trauma Shock [online] 2010, 3(2):129-136 [viewed09 July 2014] Available from: doi:10.4103/0974-2700.62111
  4. APPELBOAM A, REUBEN A, MANN C, LOBBAN T, EWINGS P, BENGER J, VICKERY J, BARTON A, GAGG J. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study BMJ Open [online] , 4(3):e004525 [viewed 09 July 2014] Available from: doi:10.1136/bmjopen-2013-004525
  5. TRAPPE HJ. Emergency therapy of maternal and fetal arrhythmias during pregnancy J Emerg Trauma Shock [online] 2010, 3(2):153-159 [viewed 09 July 2014] Available from: doi:10.4103/0974-2700.62116
  6. ALPERT BRUCE S., BOINEAU JOHN, STRONG WILLIAM B.. Exercise-induced ventricular tachycardia. Pediatr Cardiol [online] 1982 March, 2(1):51-55 [viewed 09 July 2014] Available from: doi:10.1007/BF02265617
  7. RYAN T. J., ANDERSON J. L., ANTMAN E. M., BRANIFF B. A., BROOKS N. H., CALIFF R. M., HILLIS L. D., HIRATZKA L. F., RAPAPORT E., RIEGEL B. J., RUSSELL R. O., SMITH E. E., WEAVER W. D.. ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction:Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation [online] 1996 November, 94(9):2341-2350 [viewed 09 July 2014] Available from: doi:10.1161/01.CIR.94.9.2341
  8. REIFFEL J. A.. The Implantable Cardioverter-Defibrillator: Patient Perspective. [online] 2002 March, 105(9):1022-1024 [viewed 09 July 2014] Available from: doi:10.1161/hc0902.105131

Management - Specific Treatments

Fact Explanation
Anti arrhythmic drug therapy [1] ACC/AHA/ESC guidelines recommend combination of amiodarone and beta blockers when symptoms do not respond to beta blocker or when there's myocardial infarction resulting in ventricular dysfunction. In patients with heart failure beta receptor–blocking drugs (metoprolol, carvedilol, and bisoprolol), Angiotensin-converting enzyme inhibitors (ACEI), Aldosterone antagonists are used [1] [7]
Radiofrequency catheter ablation [2] [3] Cardiomyopathy, bundle-branch block, and and myocardial infarction causing a dysfunctional ventricles benefit from this [2] [3]
Implantable cardioverter defibrillator implantation [4] [5] [6] When a patient has hemodynamically unstable VT, unexplained syncope, familial sudden death syndromes ICD implantation may be beneficial. [4] [5] [6]
References
  1. 1) MCCANN G. Pharmacological treatment of significant cardiac arrhythmias. [online] 2000 October, 34(5):401-402 [viewed 09 July 2014] Available from: doi:10.1136/bjsm.34.5.401
  2. TUNG R., BOYLE N. G., SHIVKUMAR K.. Catheter Ablation of Ventricular Tachycardia. Circulation [online] December, 122(3):e389-e391 [viewed 09 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.110.963371
  3. WILLIAMS ERIC S., VISWANATHAN MOHAN N.. Current and Emerging Antiarrhythmic Drug Therapy for Ventricular Tachycardia. Cardiol Ther [online] December, 2(1):27-46 [viewed 09 July 2014] Available from: doi:10.1007/s40119-013-0012-5
  4. A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias. N Engl J Med [online] 1997 November, 337(22):1576-1584 [viewed 09 July 2014] Available from: doi:10.1056/NEJM199711273372202
  5. KATRITSIS D. Nonsustained ventricular tachycardia: where do we stand?. European Heart Journal [online] 2004 July, 25(13):1093-1099 [viewed 09 July 2014] Available from: doi:10.1016/j.ehj.2004.03.022
  6. REIFFEL J. A.. The Implantable Cardioverter-Defibrillator: Patient Perspective. [online] 2002 March, 105(9):1022-1024 [viewed 09 July 2014] Available from: doi:10.1161/hc0902.105131
  7. ZIPES D. P., et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace [online] 2006 September, 8(9):746-837 [viewed 05 September 2014] Available from: doi:10.1093/europace/eul108