Nonsustained ventricular tachycardia in ischemic heart disease: when and which pharmacological treatment?
Nonsustained ventricular tachycardia is not uncommon both in the presence and absence of organic heart disease and in the latter situation, is usually not associated with an increased risk. However, in patients with ischemic heart disease, especially in the post-infarction period, nonsustained ventricular tachycardia is associated with an increased risk of sudden, and possibly non-sudden, cardiac death. Several non-invasive and invasive tests have been utilized, individually or in combination, to risk stratify those patients. Left ventricular ejection fraction, the signal averaged electrocardiogram, and especially programmed ventricular stimulation have been commonly utilized to identify those patients at high risk for malignant tachyarrhythmias and to evaluate the potential benefit from antiarrhythmic treatment. At present, however, there is no consensus as to the best strategy to identify and treat high risk patients. Several ongoing multicenter clinical trials may eventually provide such guidelines. In the meantime, an algorithm for the management of those patients is suggested.
El-Sherif
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State University of New York Science Center, Brooklyn, New York, USA.
Turitto
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G
D000200:Action Potentials; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents