Ventricular tachycardia in the absence of structural heart disease

Komandoor Srivathsan, Steven Jay Lester, Christopher P. Appleton, Luis Scott, Thomas M. Munger

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

In up to 10% of patients who present with ventricular tachycardia (VT), obvious structural heart disease is not identified. In such patients, causes of ventricular arrhythmia include right ventricular outflow tract (RVOT) VT, extrasystoles, idiopathic left ventricular tachycardia (ILVT), idiopathic propranolol-sensitive VT (IPVT), catecholaminergic polymorphic VT (CPVT), Brugada syndrome, and long QT syndrome (LQTS). RVOT VT, ILVT, and IPVT are referred to as idiopathic VT and generally do not have a familial basis. RVOT VT and ILVT are monomorphic, whereas IPVT may be monomorphic or polymorphic. The idiopathic VTs are classified by the ventricle of origin, the response to pharmacologic agents, catecholamine dependence, and the specific morphologic features of the arrhythmia. CPVT, Brugada syndrome, and LQTS are inherited ion channelopathies. CPVT may present as bidirectional VT, polymorphic VT, or catecholaminergic ventricular fibrillation. Syncope and sudden death in Brugada syndrome are usually due to polymorphic VT. The characteristic arrhythmia of LQTS is torsades de pointes. Overall, patients with idiopathic VT have a better prognosis than do patients with ventricular arrhythmias and structural heart disease. Initial treatment approach is pharmacologic and radiofrequency ablation is curative in most patients. However, radiofrequency ablation is not useful in the management of inherited ion channelopathies. Prognosis for patients with VT secondary to ion channelopathies is variable. High-risk patients (recurrent syncope and sudden cardiac death survivors) with inherited ion channelopathies benefit from implantable cardioverter-defibrillator placement. This paper reviews the mechanism, clinical presentation, and management of VT in the absence of structural heart disease.

Original languageEnglish (US)
Pages (from-to)106-121
Number of pages16
JournalIndian Pacing and Electrophysiology Journal
Volume5
Issue number2
StatePublished - Apr 2005

Fingerprint

Ventricular Tachycardia
Heart Diseases
Channelopathies
Brugada Syndrome
Long QT Syndrome
Cardiac Arrhythmias
Propranolol
Ions
Syncope
Torsades de Pointes
Ventricular Premature Complexes
Implantable Defibrillators
Sudden Cardiac Death
Ventricular Fibrillation
Sudden Death
Catecholamines
Survivors

Keywords

  • Structurally normal heart
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ventricular tachycardia in the absence of structural heart disease. / Srivathsan, Komandoor; Lester, Steven Jay; Appleton, Christopher P.; Scott, Luis; Munger, Thomas M.

In: Indian Pacing and Electrophysiology Journal, Vol. 5, No. 2, 04.2005, p. 106-121.

Research output: Contribution to journalArticle

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