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infusion of 05 mg/min for an additional 18 42 hours can be used If the ventricular tachycardia recurs, supplemental amiodarone infusions of 150 mg over 10 minutes can be given If the patient is stable, intravenous procainamide, 20 mg/min intravenously (up to 1000 mg), followed by an infusion of 20 80 mcg/kg/min could also be tried Empiric magnesium replacement (1 g intravenously) may help Ventricular tachycardia can also be terminated by ventricular overdrive pacing, and this approach is useful when the rhythm is recurrent

ular arrhythmias -blockers reduce the incidence of sudden death by 40 50% and should be routine therapy (see section on Heart Failure) Although there are no definitive data with amiodarone in this group, trends from a number of studies suggest that it may be beneficial Other antiarrhythmic agents should generally be avoided because their proarrhythmic risk appears to outweigh any benefit, even in patients with inducible arrhythmias that are successfully suppressed in the electrophysiology laboratory

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Ermis C et al Comparison of ventricular arrhythmia frequency in patients with ischemic cardiomyopathy versus nonischemic cardiomyopathy treated with implantable cardioverter defibrillators Am J Cardiol 2005 Jul 15;96(2):233 8 [PMID: 16018849] Katritsis DG et al Nonsustained ventricular tachycardia: where do we stand Eur Heart J 2004 Jul;25(13):1093 9 [PMID: 15231366] Wietholt D et al Prevention of sustained ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators the PREVENT study J Interv Card Electrophysiol 2003 Dec;9 (3):383 9 [PMID: 14618061]

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1 Sustained ventricular tachycardia Patients with symptomatic or sustained ventricular tachycardia in the absence of a reversible precipitating cause (acute myocardial infarction or ischemia, electrolyte imbalance, drug toxicity, etc) are at high risk for recurrence In those with significant LV dysfunction, subsequent sudden death is common Several trials, including the Antiarrhythmic Drug Versus Implantable Defibrillator (AVID) and the Canadian Implantable Defibrillator trials, strongly suggest that these patients should be managed with implantable cardioverter-defibrillator devices (ICDs) In those with preserved LV function, the mortality rate is lower and the etiology is often different than in those with depressed ventricular function Treatment with amiodarone, optimally in combination with a -blocker, may be adequate Sotalol may be an alternative, though there is less supporting evidence However, many times if ventricular tachycardia occurs in a patient with preserved ventricular function, it is either an outflow tract tachycardia or a fascicular ventricular tachycardia, and these arrhythmias will often respond to AV nodal blockers and can be effectively treated with catheter ablation The role of electrophysiologic studies in this group is less clear than was previously thought, but they may help identify patients who are candidates for radiofrequency ablation of a ventricular tachycardia focus This is particularly the case for arrhythmias that originate in the RV outflow tract (appearing as left bundle branch block with inferior axis on the surface ECG), the posterior fascicle (right bundle branch block, superior axis morphology), or sustained bundle branch reentry Catheter ablation can be used as a palliative therapy for those patients with recurrent tachycardia who receive ICD shocks despite antiarrhythmic therapy 2 Nonsustained ventricular tachycardia (NSVT) NSVT is defined as runs of three or more ventricular beats lasting less than 30 seconds These may be symptomatic (usually experienced as light-headedness) or asymptomatic In individuals without heart disease, NSVT is not clearly associated with a poor prognosis However, in patients with structural heart disease, particularly when they have reduced EFs, there is an increased risk of subsequent symptomatic ventricular tachycardia or sudden death -Blockers reduce these risks in patients who have coronary disease with significant LV systolic dysfunction (EFs < 35 40%), but if sustained ventricular tachycardia has been induced during electrophysiologic testing, an implantable defibrillator may be indicated In patients with chronic heart failure and reduced EFs whether due to coronary disease or primary cardiomyopathy and regardless of the presence of asymptomatic ventric-.

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