Which patient with sustained ventricular tachycardia is suited for long-term therapy with anti-arrhythmia drugs?
Steinbeck, G.
Zeitschrift für die Gesamte Innere Medizin und ihre Grenzgebiete 47(5): 195-201
1992
ISSN/ISBN: 0044-2542 PMID: 1615729 Document Number: 398768
Therapy of patients with a history of sustained ventricular tachycardia essentially depends on the type and extent of underlying cardiac disease. This survey presents older and newer results regarding the outcome of this arrhythmia in relation to QRS morphology and underlying disease: monomorphic ventricular tachycardia without underlying cardiac disease; monomorphic ventricular tachycardia on the basis of right ventricular dysplasia; monomorphic ventricular tachycardia in coronary artery disease or dilated cardiomyopathy; polymorphic ventricular tachycardia with/without QT prolongation. Apart from complete hemodynamic evaluation of all cases with documented sustained ventricular tachycardia, programmed ventricular stimulation should be performed. Because of the excellent long-term outcome and the regularly benign clinical symptomatology, antiarrhythmic drugs are and will remain the therapy of first choice in patients without underlying cardiac disease. In exercise-induced arrhythmias, beta-blocking agents are to be used in the first place. As an exception to the general rule, special forms of ventricular tachycardia without underlying cardiac disease respond to verapamil. The clinical symptomatology during ventricular tachycardia on the basis of coronary artery disease or dilated cardiomyopathy is typically severe with a guarded outcome. Long-term therapy with antiarrhythmic drugs should be performed only when the efficacy was proved by serial electrophysiologic drug testing (suppression of inducibility of the arrhythmia). Regarding drug testing, the class III antiarrhythmic drugs sotalol and amiodarone seem to be more effective than the class I antiarrhythmic drugs.