Nonsustained Ventricular Tachycardia in the Normal Heart Risk Stratification and Management

摘要

Nonsustained ventricular tachycardia (NSVT) is defined as 3 of more consecutive beats of ventricular origin at a rate of 100 beats/min or greater, lasting less than 30 seconds, usually diagnosed on Holter monitor, telemetry, event recorder, or exercise treadmill test. A nonsustained wide-complex tachycardia should be approached in a systematic fashion, considering alternative diagnoses of artifact, paced rhythm, and supraventricular tachycardia with aberrancy, in addition to NSVT. Distinction should be made between nonsustained monomorphic and polymorphic ventricular tachycardia, because these entities have distinct differential diagnoses and prognoses. A careful approach to exclusion of cardiac ischemia, structural heart disease, and inherited electrical disease should be undertaken before concluding that a patient has a normal heart. Treatment options for NSVT in patients with a normal heart without structural or inherited/genetic disease include observation and reassurance; medical therapy with p-blockers, calcium channel blockers, or antiarrhythmic drugs; and ablative therapy. An implantable cardioverter-defibrillator is rarely needed.