Nonsustained ventricular tachycardia: Current evaluation and management
Nonsustained ventricular tachycardia (VT) has been an intimidating diagnosis for many physicians because its presence, in general, portends an increased risk of sudden death. The management and approach has been quite diverse and inconsistent in part due to the absence of a large body of literature. There have been major developments, however, over the last two decades in better understanding the mechanism of VPCs and ventricular tachycardia as well as adopting a more systematic approach to diagnosis and management. With the publication of the results of CAST I and II, there has been a movement away from empiric treatment of asymptomatic VPCs and nonsustained VT, and an emphasis on risk stratification on the basis of the underlying heart disease. Coronary artery disease, by far, is the most common etiology for heart disease in the United States, but there are numerous other conditions such as hypertrophic and dilated cardiomyopathies, as well as right ventricular dysplasia and 'normal heart' ventricular tachycardias that require a tailored approach. Noninvasive and invasive methods of risk stratification, such as measurement of heart rate variability and signal averaged ECG's, as well as electrophysiologic testing, respectively, have enabled us to identify 'high risk' patients that may benefit from therapy whether it be antiarrhythmics or implantable defibrillators. Recent and on- going prospective trials such as the CAMIAT, EMIAT, GESICA, MADIT, MUSTT, and CABG-PATCH will hopefully further our knowledge base and make the management of VPCs and nonsustained VT a more uniform process.
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