ABSTRACT
Underlying causes of ventricular tachycardia (VT) or complex ventricular arrhythmias (VA) should be treated if possible. Antiarrhythmic drugs are generally not used to treat asymptomatic patients with complex VA and no heart disease. Beta blockers are the only antiarrhythmic drugs that have been documented to reduce mortality in patients with VT or complex VA in the setting of structural heart disease. Radiofrequency catheter ablation of VT has been beneficial in treating selected patients with monomorphic VT and ventricular fibrillation (VF). The implantable cardioverter-defibrillator (ICD) is the most effective treatment for patients with life-threatening VT or VF. The American College of Cardiology Foundation/American Heart Association Class I and IIa indications for an ICD are discussed. Patients with structural heart disease (SHD) and ICDs should be treated with guideline directed medical therapy. Patients with idiopathic VT (absence of SHD) do not require ICD implamtation.
The presence of three or more consecutive ventricular premature complexes (VPCs) on an electrocardiogram (ECG) is diagnosed as ventricular tachycardia (VT) (1,2). VT is considered sustained if it lasts ≥30 seconds and nonsustained if its lasts <30 seconds (2). Complex ventricular arrhythmias (VA) include VT or paired, multiform, or frequent VPCs. For this chapter we consider frequent VPCs an average of ≥30/hour on a 24-hour ambulatory electrocardiogram (AECG) or ≥6/minute on a 1-minute rhythm strip of an ECG (2,3). Simple VA includes infrequent VPCs and no complex forms.
