Nonsustained ventricular tachycardia

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Background

Definition[1][2]

  • >3-5 consecutive beats originating below the AV node
  • Rate > 100bpm
  • Duration <30s

Epidemiology

  • Occurs in 0-4% of ambulatory patients
  • Increased frequency in males and with increasing age

Clinical Features

  • Often asymptomatic
  • In some patients, NSVT is associated with an increased risk of sustained tachyarrhythmias and sudden cardiac death. In others it is of little prognostic significance.

Differential Diagnosis

Most important distinction is whether dysrhythmia is associated with underlying structural heart disease.

NSVT in the absence of apparent structural heart disease

  • Idiopathic Ventricular Tachycardia: Ventricular outflow arrhythmias (RVOT > LVOT). Good prognosis, rarely associated with tachycardia-induced cardiomyopathy and sudden cardiac death (SCD).
  • Polymorphic Ventricular Tachycardia: Inherited or acquired LQTS, familial catecholaminergic PMVT. Increased risk of SCD, consideration for ICD if symptomatic (syncope, arrest) or asymptomatic QTc > 550ms.
  • Arrhythmogenic Right Ventricular Cardiomyopathy: Fibro-fatty deposition in RVIT/RVOT/RV apex. Increased risk of SCD, consideration for catheter ablation with ICD backup.

NSVT with apparent structural heart disease

  • Hypertension and LVH: Occurrence of NSVT warrants evaluation for ischemic heart disease, aggressive medical management of hypertension (including beta-blockade). Prognosis unclear.
  • Valvular disease: Highest incidence in AS and MR. No evidence that occurrence of NSVT associated with SCD.
  • Ischemic heart disease: Monomorphic NSVT around myocardial scars, active ischemia associated with both mono/polymorphic VT and VF. In ED, early NSVT (<24h) after NSTEMI/STEMI common and not associated with adverse outcomes.
  • Hypertrophic cardiomyopathy: Genetic myocardial disease, myocyte disarray produces arrhythmogenic substrate. NSVT associated with increased risk of SCD.
  • Other conditions:
    • Non-ischemic dilated cardiomyopathy
    • Giant-cell myocarditis
    • Repaired TOF
    • Amyloidosis
    • Sarcoidosis
    • Chagas cardiomyopathy

Diagnosis

In all patients:

  • History: including arrhythmogenic medications/substances, pertinent family history
  • Physical examination
  • ECG/CXR
  • TTE

In selected patients:

  • Exercise testing
  • Advanced imaging (CT/C-MR)
  • Electrophysiologic studies
  • Genetic testing

Management

Disposition

See Also

External Links

References

  1. ↑ Katritsis DG, Zareba W, Camm AJ. Nonsustained ventricular tachycardia. J Am Coll Cardiol. 2012;60(20):1993–2004. doi:10.1016/j.jacc.2011.12.063.
  2. ↑ Wellens HJ. Electrophysiology: Ventricular tachycardia: diagnosis of broad QRS complex tachycardia. Heart. 2001;86(5):579–585.
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