History

Fact Explanation
May have a congential etiology When ventricles beat very fast (120 to 300 beats per minute), and neither coordinated with the atria it is called a ventricular tachycardia. Most commonly VT is seen in a weak cardiac musculature due to a cardiomyopathy, or when there's scarring of the heart due to prior myocardial infarction. But channelopathies,electrolyte imbalances, structural heart disease such as tetralogy of Fallot, systemic diseases such as rhematoid arthritis, certain drugs can also cause a VT. The pathophysiology of the arrhythmia is usually caused by electrical reentry or abnormal automaticity. Inherited channelopathies such as long/short QT syndromes, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome have a congenital etiology. When there's beat to beat variation of the QRS complex, it's called polymorphic VT and if similar it's called monomorphic VT [9] [10] [11]
Palpitations [1] [7] Sensation of pounding of the heart is due to abnormal rhythm [1] [7]
Light-headedness/ Syncope [2] [7] Due to cerebral hypo-perfusion due to extreme tachycardia [2] [7]
Chest pain [1] [7] Can be due to ischaemia or palpitations it self [1] [7]
Anxiety [1] [7] Due to palpitations [1] [7]
Sudden death [2] [6] [7] In catecholaminergic polymorphic ventricular tachycardia (CPVT) there can be episodes of syncope, seizures, or sudden death [2] [6] [7]
References
  1. KOLETTIS THEOFILOS M.. Ventricular tachyarrhythmias during acute myocardial infarction: The role of endothelin-1. Life Sciences [online] 2014 January [viewed 24 June 2014] Available from: doi:10.1016/j.lfs.2014.01.060
  2. 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 24 June 2014] Available from: doi:10.5041/RMMJ.10086
  3. TOKUDA M, KOJODJOJO P, TUNG S, TEDROW UB, NOF E, INADA K, KOPLAN BA, MICHAUD GF, JOHN RM, EPSTEIN LM, STEVENSON WG. Acute Failure of Catheter Ablation for Ventricular Tachycardia Due to Structural Heart Disease: Causes and Significance J Am Heart Assoc [online] , 2(3):e000072 [viewed 24 June 2014] Available from: doi:10.1161/JAHA.113.000072
  4. GHANEM MT, AHMED RS, ABD EL MOTELEB AM, ZARIF JK. Predictors of Success in Ablation of Scar-Related Ventricular Tachycardia Clin Med Insights Cardiol [online] :87-95 [viewed 24 June 2014] Available from: doi:10.4137/CMC.S11501
  5. KATRITSIS D. Nonsustained ventricular tachycardia: where do we stand?. European Heart Journal [online] 2004 July, 25(13):1093-1099 [viewed 24 June 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 24 June 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 24 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306023
  8. HANASH CR, CROSSON JE. Emergency diagnosis and management of pediatric arrhythmias J Emerg Trauma Shock [online] 2010, 3(3):251-260 [viewed 24 June 2014] Available from: doi:10.4103/0974-2700.66525
  9. TUNG R., BOYLE N. G., SHIVKUMAR K.. Catheter Ablation of Ventricular Tachycardia. Circulation [online] December, 122(3):e389-e391 [viewed 05 September 2014] Available from: doi:10.1161/CIRCULATIONAHA.110.963371
  10. WELLENS H. J.. ELECTROPHYSIOLOGY: Ventricular tachycardia: diagnosis of broad QRS complex tachycardia. [online] 2001 November, 86(5):579-585 [viewed 05 September 2014] Available from: doi:10.1136/heart.86.5.579
  11. VOSKUYL A. E.. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology [online] 2006 October, 45(Supplement 4):iv4-iv7 [viewed 05 September 2014] Available from: doi:10.1093/rheumatology/kel313

Examination

Fact Explanation
Tachycardia [1] [2] [3] VT is usually caused by electrical reentry or abnormal automaticity and this results in tachycardia [1] [2] [3]
Hypotension [3] Prolonged VT could result in hypotension due to incomplete filling and incoordinated contractions. [3]
Tachypnoea [3] Prolonged VT could result in increased respiratory rate [3]
diaphoresis [3] Sometimes patients may present with haemodynamic instability due to prolonged VT 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 VT 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 VT 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] This is observed if atria are in sinus rhythm [4]
Murmers [7] When a valvular disease or hypertrophic obstructive cardiomyopathy causes the VT, murmurs may be heard. [7]
Displaced apex [7] Due to cardiomegaly due to underlying ischaemic heart disease [7]
Rales on respiratory system examination [7] 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 loss of atrioventricular (AV) synchrony. [6]
References
  1. KATRITSIS D. Nonsustained ventricular tachycardia: where do we stand?. European Heart Journal [online] 2004 July, 25(13):1093-1099 [viewed 24 June 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 24 June 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 24 June 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 24 June 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 24 June 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 24 June 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 24 June 2014] Available from: doi:10.1161/01.CIR.90.6.3103

Differential Diagnoses

Fact Explanation
Atrial Fibrillation [1] This is the most common cardiac arrhythmia, and can lead to heart failure, stroke, and death and this can mimic VT [1]
Atrial Flutter [2] This gives a sawtooth pattern on the electrocardiogram (ECG) and clinical presentation may mimic VT [2]
Ventricular Fibrillation (VF) [3] Rapid, polymorphic VT may be difficult to distinguish from VF in which QRS complexes are very irregular and this condition is life threatening [3]
Pacemaker induced tachycardia [4] Sometimes these can generate tachycardias and considered as a differential diagnosis [4]
Wolff-Parkinson-White syndrome [5] There is an accessory pathway between the atrium and ventricle and patients with WPW syndrome have clinical symptoms that mimic VT [5]
Accelerated idioventricular rhythm [6] This is slower than VT and considered as a good change in electrocardiogram which clinicians like to see after reperfusion therapy. [6]
Supraventricular tachycardia with abberant conduction [7] This is clinically similar to VT and also produces a broad complex tachycardia in electrocardiogram[7]
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 24 June 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 24 June 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 24 June 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 24 June 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 24 June 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 24 June 2014] Available from: doi:10.4103/1119-3077.127545
  7. WANG P. J.. Supraventricular Tachycardia. [online] 2002 December, 106(25):206e-208 [viewed 24 June 2014] Available from: doi:10.1161/​01.CIR.0000044341.43780.C7

Investigations - for Diagnosis

Fact Explanation
Electrocardiography (ECG [1] Broad complex tachycardia (BCT) is seen. Some of ECG differential diagnosis are supraventricular tachycardia (SVT) with aberrant conduction and bundle branch block (BBB) [1]
Serum electrolytes [2] As electrolyte disturbances commonly cause VT, it's important to screen for electrolyte abnormalities. Hypokalemia, hypomagnesemia, and hypocalcemia might cause VT or torsades de pointes. [2]
Serum drug levels and toxicology screen [3] Overdose of Digoxin, Tri-cyclic antidepressants, cocaine drug levels as these may cause VT [3]
Serum cardiac markers [4] Myocardial ischemia or infarction can lead to VT, therefore serum cardiac markers are measured. [4]
Echocardiography [5] This is done to diagnose the underlying disease which could be hypertrophic, dilated, or right ventricular cardiomyopathy, segmental hypokinesia due to myocardial infarction [5]
Cardiac imaging studies [6] [9] When echocardiography results are inconclusive, to detect structural heart diseases this is done. [6] [9]
Monitoring devices [7] [8] 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 [7] [8]
Myocardial biopsy [9] This could be important to diagnose hypertrophic cardiomyopathy, arrhythmogenic right ventricular disease or sarcoidosis, amyloidosis [9]
Electrophysiological studies (EPS) [10] When a patient has a history of myocardial infarction, or has clinical symptoms of VT rarely these tests are done. [10]
References
  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 25 June 2014] Available from: doi:10.1093/europace/euq430
  2. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation [online] 2005 November, 112(24_suppl):IV-121-IV-125 [viewed 25 June 2014] Available from: doi:10.1161/​CIRCULATIONAHA.105.166563
  3. HAUPTMAN P. J., KELLY R. A.. Digitalis. Circulation [online] 1999 March, 99(9):1265-1270 [viewed 25 June 2014] Available from: doi:10.1161/​01.CIR.99.9.1265
  4. TANINDI A, CEMRI M. Troponin elevation in conditions other than acute coronary syndromes Vasc Health Risk Manag [online] 2011:597-603 [viewed 25 June 2014] Available from: doi:10.2147/VHRM.S24509
  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 25 June 2014] Available from: doi:10.1038/nature13233
  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 25 June 2014] Available from: doi:10.2214/AJR.10.5666
  7. CANTILLON D. J.. Evaluation and management of premature ventricular complexes. Cleveland Clinic Journal of Medicine [online] December, 80(6):377-387 [viewed 25 June 2014] Available from: doi:10.3949/ccjm.80a.12168
  8. ZIMETBAUM P., GOLDMAN A.. Ambulatory Arrhythmia Monitoring: Choosing the Right Device. Circulation [online] December, 122(16):1629-1636 [viewed 25 June 2014] Available from: doi:10.1161/​CIRCULATIONAHA.109.925610
  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 25 June 2014] Available from: doi:10.1161/​CIRCULATIONAHA.110.944538
  10. KOLANDAIVELU ARAVINDAN, LARDO ALBERT C, HALPERIN HENRY R. Cardiovascular magnetic resonance guided electrophysiology studies. Array [online] 2009 December [viewed 25 June 2014] Available from: doi:10.1186/1532-429X-11-21

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. [3]
Coagulation studies [3] To exclude any coagulopathy. [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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 [1] [2] [3] Intravenous (IV) procainamide, sotalol, Lidocaine is used in a stable patient [1]
Correction of electrolyte abnormalities [4] hypokalemia or hypomagnesemia from diuretic use should be corrected first [4]
Correction of drug toxicity [4] Treatment with anti-digitalis antibody is required if Digitalis toxicity is suspected [4]
Dietary management [6] low-cholesterol diets, low-salt diets, or both are recommended for patients with VT and caffeine which is a stimulant is also helpful. [6]
Activity [5] Increased sympathetic tone during strenuous physical exertion can stimulate a VT. Therefore it's better avoided [5]
Patient education [7] patient education regarding nature, course, prognosis of disease, the precautions after starting anti arrhythmic therapy, or ICD implantation is needed. [7]
Patient identification [7] When a patient presents with syncope, cardiac arrest, patient identification with a bracelet/ diagnosis card is helpful for further management [7]
References
  1. HANASH CR, CROSSON JE. Emergency diagnosis and management of pediatric arrhythmias J Emerg Trauma Shock [online] 2010, 3(3):251-260 [viewed 25 June 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 25 June 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 [viewed 25 June 2014] Available from: doi:10.4103/0974-2700.62111
  4. RAVIELE A., GIADA F., BERGFELDT L., BLANC J. J., BLOMSTROM-LUNDQVIST C., MONT L., MORGAN J. M., RAATIKAINEN M. J. P., STEINBECK G., VISKIN S., KIRCHHOF P., BRAUNSCHWEIG F., BORGGREFE M., HOCINI M., BELLA P. D., SHAH D. C.. Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace [online] December, 13(7):920-934 [viewed 25 June 2014] Available from: doi:10.1093/europace/eur130
  5. ALPERT BRUCE S., BOINEAU JOHN, STRONG WILLIAM B.. Exercise-induced ventricular tachycardia. Pediatr Cardiol [online] 1982 March, 2(1):51-55 [viewed 25 June 2014] Available from: doi:10.1007/BF02265617
  6. 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 25 June 2014] Available from: doi:10.1161/​01.CIR.94.9.2341
  7. REIFFEL J. A.. The Implantable Cardioverter-Defibrillator: Patient Perspective. [online] 2002 March, 105(9):1022-1024 [viewed 25 June 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. MCCANN G. Pharmacological treatment of significant cardiac arrhythmias. [online] 2000 October, 34(5):401-402 [viewed 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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 25 June 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