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Srivathsan K, Lester SJ, Appleton CP, et al. Ventricular tachycardia in the absence of structural heart disease. Indian Pacing Electrophysiol J. 2005;5(2):106-21
Srivathsan, K., Lester, S. J., Appleton, C. P., Scott, L. R., & Munger, T. M. (2005). Ventricular tachycardia in the absence of structural heart disease. Indian pacing and electrophysiology journal, 5(2), 106-21.
Srivathsan, Komandoor, et al. "Ventricular tachycardia in the absence of structural heart disease." Indian pacing and electrophysiology journal vol. 5,2 (2005): 106-21.
Srivathsan K, Lester SJ, Appleton CP, Scott LR, Munger TM. Ventricular tachycardia in the absence of structural heart disease. Indian Pacing Electrophysiol J. 2005 Apr 01;5(2):106-21. PMID: 16943951; PMCID: PMC1502082.
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Indian Pacing Electrophysiol J. 2005 Apr 01;5(2):106-21.

Ventricular tachycardia in the absence of structural heart disease.

Indian pacing and electrophysiology journal

Komandoor Srivathsan, Steven J Lester, Christopher P Appleton, Luis R P Scott, Thomas M Munger

Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. [email protected]

PMID: 16943951 PMCID: PMC1502082

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.

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