Ventricular Tachycardia and Sudden Cardiac Death

doi:10.4065/84.3.289

Mayo Clinic Proceedings

Volume 84, Issue 3, March 2009, Pages 289-297

https://doi.org/10.4065/84.3.289 Get rights and content

Ventricular tachycardia (VT), which most commonly occurs in patients with structural heart disease, can be associated with an increased risk of sudden death. The most common cause of ventricular fibrillation is acute coronary ischemia, whereas a myocardial scar from prior infarct is the most common cause of sustained monomorphic VT in patients with structural heart disease. More benign forms of idiopathic VT can also occur in the absence of structural heart disease. Treatment of VT involves both emergent management and prevention of recurrence with medical and device therapy. Appropriately selected patients who have experienced VT or those who are at risk of VT may be candidates for an implantable cardioverter-defibrillator. The left ventricular ejection fraction is most frequently used to stratify patients with either ischemic or nonischemic cardiomyopathy who are at risk of sudden death and may be candidates for a prophylactic defibrillator. Catheter ablation may also be an option for appropriately selected patients with many forms of VT. This article discusses the etiologies and management of VT and its association with sudden death.

Section snippets

Ventricular Tachycardia With Structural Heart Disease

Although usually associated with structural heart disease, VT can occur in its absence. Ischemic heart disease is the most common cause of sustained ventricular arrhythmias. Acute coronary ischemia is a cause of polymorphic VT or ventricular fibrillation (VF) and is probably the most common cause of out-of-hospital sudden death. During acute ischemia, the leakage of potassium leads to increased extracellular potassium that depolarizes myocytes in the ischemic border zone.1, 2 This

Emergent Management and Initial Evaluation

Regardless of the etiology, emergent cardioversion is warranted for sustained VT that is causing symptomatic hypotension, pulmonary edema, or myocardial ischemia. An algorithm for the emergent resuscitation of ventricular arrhythmias (adapted from The American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care) is shown in Figure 2.²⁴ Reversible causes, such as acute ischemia, electrolyte abnormalities, or drug toxicities, should be corrected.

CONCLUSION

Ventricular tachycardia is an important cause of sudden death. The risk and consequently the therapeutic approach are determined by the underlying heart disease. Ventricular tachycardia is most commonly associated with ischemic heart disease or other forms of structural heart disease that are associated with a risk of sudden death. Several groups of patients who are at increased risk of sudden death from VT have been identified and benefit from ICDs. It is important to distinguish high-risk

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SYMPOSIUM ON CARDIOVASCULAR DISEASESVentricular Tachycardia and Sudden Cardiac Death

Section snippets

Ventricular Tachycardia With Structural Heart Disease

Emergent Management and Initial Evaluation

CONCLUSION

Am J Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Prog Cardiovasc Dis

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Heart Rhythm

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Heart Rhythm

J Am Coll Cardiol

Distribution of extracellular potassium and electrophysiologic changes during two-stage coronary ligation in the isolated, perfused canine heart

Circulation

Mechanisms underlying the development of ventricular fibrillation during early myocardial ischemia

Circ Res

Canine ventricular arrhythmias in the late myocardial infarction period, 8: epicardial mapping of reentrant circuits

Circ Res

Sustained bundle branch reentry as a mechanism of clinical tachycardia

Circulation

Transcatheter electrical ablation of right bundle branch: a method of treating macroreentrant ventricular tachycardia attributed to bundle branch reentry

Circulation

Spectrum of mutations in long-QT syndrome genes: KVLQT1, HERG, SCN5A, KCNE1, and KCNE2

Circulation

Catecholaminergic polymorphic ventricular tachycardia in children: a 7-year follow-up of 21 patients

Circulation

Mutations in the cardiac ryanodine receptor gene (hRyR2) underlie catecholaminergic polymorphic ventricular tachycardia

Circulation

Absence of calsequestrin 2 causes severe forms of catecholaminergic polymorphic ventricular tachycardia

Circ Res

Arrhythmogenic right ventricular dysplasia: a United States experience

Circulation

SYMPOSIUM ON CARDIOVASCULAR DISEASES
Ventricular Tachycardia and Sudden Cardiac Death