Materiały źródłowe

• #1 Ventricular Tachycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532954/

  Ventricular tachycardia (VT) is a wide complex arrhythmia of ventricular origin, defined as three or more consecutive beats at a rate of more than 100 beats per minute. Sustained ventricular tachycardia is defined as tachycardia that continues for more than 30 seconds or leads to hemodynamic compromise within 30 seconds and requires intervention. […] This activity reviews the evaluation and management of ventricular tachycardia and highlights the importance of an interprofessional team in managing patients with ventricular tachycardia. […] […] The clinical presentation of ventricular tachycardia varies from palpitation to sudden cardiac death. For appropriate management of VT and prevention of sudden cardiac death, it is essential to understand the pathophysiology of ventricular tachycardia and underlying structural heart disease. In this chapter, we summarize the etiology and epidemiology of ventricular tachycardia and discuss the evaluation and management of patients present with ventricular tachycardia.

• #2 Ventricular tachycardia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/diagnosis-treatment/drc-20355144

  Ventricular tachycardia treatment at Mayo Clinic […] A Mayo Clinic healthcare professional delivers specialized care for ventricular tachycardia. […] Ventricular tachycardia that lasts longer than 30 seconds, called sustained V-tach, needs emergency medical treatment. Sustained V-tach may sometimes lead to sudden cardiac death. […] The goals of ventricular tachycardia treatment are to: […] – Slow a rapid heartbeat. […] – Prevent future episodes of a fast heartbeat. […] Ventricular tachycardia treatment may include medicines, procedures and devices to control or reset the heart rhythm, and heart surgery. […] If another medical condition is causing tachycardia, treating the underlying problem may reduce or prevent episodes of a fast heartbeat. […] Medicines are given to slow the fast heart rate. Medicines used to treat tachycardia may include beta blockers. You may need more than one medicine. Talk to your healthcare team about the type of medicine that is best for you.

• #3 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Ventricular tachycardia (VT) is a crucial cause of sudden cardiac death (SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. […] The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. […] In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.

• #4 Ventricular Tachycardia Treatment & Management: Approach Considerations, Initial Supportive Management, Cardioversion in Acute Ventricular Tachycardia

  https://emedicine.medscape.com/article/159075-treatment

  Sustained ventricular tachycardia (VT) may lead to hemodynamic collapse. Consequently, these patients require urgent conversion to sinus rhythm. The strategy for conversion depends on whether the patient is hemodynamically stable or unstable. […] Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion, usually at a starting energy dose of 100 J (monophasic; comparable biphasic recommendations are not currently available). Unstable polymorphic VT is treated with immediate defibrillation. […] In stable patients with monomorphic VT and normal LV function, restoration of sinus rhythm is typically achieved with intravenous (IV) procainamide, amiodarone, or sotalol. […] If medical therapy is unsuccessful, synchronized cardioversion (50-200 J monophasic) following sedation is appropriate.

• #5 Ventricular Tachycardia Treatment & Management: Approach Considerations, Initial Supportive Management, Cardioversion in Acute Ventricular Tachycardia

  https://emedicine.medscape.com/article/159075-treatment

  Sustained ventricular tachycardia (VT) may lead to hemodynamic collapse. Consequently, these patients require urgent conversion to sinus rhythm. The strategy for conversion depends on whether the patient is hemodynamically stable or unstable. […] Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion, usually at a starting energy dose of 100 J (monophasic; comparable biphasic recommendations are not currently available). Unstable polymorphic VT is treated with immediate defibrillation. […] In stable patients with monomorphic VT and normal LV function, restoration of sinus rhythm is typically achieved with intravenous (IV) procainamide, amiodarone, or sotalol. […] If medical therapy is unsuccessful, synchronized cardioversion (50-200 J monophasic) following sedation is appropriate.

• #6 Ventricular Tachycardia • LITFL • CCC Cardiology

  https://litfl.com/ventricular-tachycardia/

  MANAGEMENT […] PULSELESS […] ACLS protocol […] Immediate unsynchronised defibrillation […] CPR with minimal interruption (30:2, with 2 minute cycles) […] Intubation […] O2 […] IV access […] Adrenaline 1mg Q3min […] Amiodarone 300mg (following 3rd shock) […] Exclude reversible causes (4 Hs and Ts) […] […] […] CLINICALLY COMPROMISED […] Haemodynamically unstable, chest pain, ischaemia, heart failure, VR 150/min – synchronised shock (x 3) […] O2 […] IV access […] Rapid exclusion of reversible factors (wire, PA catheter in RV, hypoK+ or Mg2+) […] Amiodarone 5mg/kg – infusion […] Synchronised DC Shock (50J Bi, 100 Mono) […] Consider:- procainamide 50mg/min- lignocaine 1mg/kg- sotalol 1mg/kg […] Repeat DC Shock (150 Bi, 360 Mono) […] Overdrive pacing […] […]

• #7 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  Therapy may be directed either at terminating an episode of the abnormal heart rhythm or at reducing the risk of another VT episode. The treatment for stable VT is tailored to the specific person, with regard to how well the individual tolerates episodes of ventricular tachycardia, how frequently episodes occur, their comorbidities, and their wishes. Individuals with pulseless VT or unstable VT are hemodynamically compromised and require immediate electric cardioversion to shock them out of the VT rhythm. […] If the patient has a pulse, meaning blood is circulating around their body and reaching vital organs, it is usually possible to terminate the episode using electric cardioversion. Cardioversion should be synchronized to the R wave in order to avoid degeneration of the rhythm to ventricular fibrillation, if possible. An initial energy of 100J is recommended. If the waveform is polymorphic, then higher energies and an unsynchronized shock should be provided (also known as defibrillation).

• #8 Pulseless ventricular tachycardia: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/pulseless-ventricular-tachycardia

  Pulseless VT requires rapid treatment. A 2020 review examined how doctors and other medical professionals treat this condition. The following steps are effective in many cases: […] Healthcare professionals use a defibrillator to lower the persons heart rate with electric shocks. They also begin cardiopulmonary resuscitation (CPR), which involves chest compressions and artificial ventilation, to maintain heart function during the treatment process. […] After the third defibrillation shock, doctors pause CPR and inject 1 milligram (mg) of adrenaline and 300 mg of amiodarone. The adrenaline kick-starts the heart, and the amiodarone reduces the heart rate. Doctors then resume CPR. […] After the fifth defibrillation shock, doctors inject 150 mg of amiodarone. […] In people with a high risk of developing pulseless VT, healthcare professionals may recommend preventive treatments, such as medications or implantable defibrillators.

• #9 Pulseless ventricular tachycardia: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/pulseless-ventricular-tachycardia

  Pulseless VT requires rapid treatment. A 2020 review examined how doctors and other medical professionals treat this condition. The following steps are effective in many cases: […] Healthcare professionals use a defibrillator to lower the persons heart rate with electric shocks. They also begin cardiopulmonary resuscitation (CPR), which involves chest compressions and artificial ventilation, to maintain heart function during the treatment process. […] After the third defibrillation shock, doctors pause CPR and inject 1 milligram (mg) of adrenaline and 300 mg of amiodarone. The adrenaline kick-starts the heart, and the amiodarone reduces the heart rate. Doctors then resume CPR. […] After the fifth defibrillation shock, doctors inject 150 mg of amiodarone. […] In people with a high risk of developing pulseless VT, healthcare professionals may recommend preventive treatments, such as medications or implantable defibrillators.

• #10 Ventricular Tachycardia Treatment & Management: Approach Considerations, Initial Supportive Management, Cardioversion in Acute Ventricular Tachycardia

  https://emedicine.medscape.com/article/159075-treatment

  Sustained ventricular tachycardia (VT) may lead to hemodynamic collapse. Consequently, these patients require urgent conversion to sinus rhythm. The strategy for conversion depends on whether the patient is hemodynamically stable or unstable. […] Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion, usually at a starting energy dose of 100 J (monophasic; comparable biphasic recommendations are not currently available). Unstable polymorphic VT is treated with immediate defibrillation. […] In stable patients with monomorphic VT and normal LV function, restoration of sinus rhythm is typically achieved with intravenous (IV) procainamide, amiodarone, or sotalol. […] If medical therapy is unsuccessful, synchronized cardioversion (50-200 J monophasic) following sedation is appropriate.

• #11 Ventricular Tachycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532954/

  […] In patients with structural heart disease and hemodynamically stable ventricular tachycardia, intravenous procainamide, amiodarone, and sotalol (depending on availability) are recommended for the acute treatment of ventricular tachycardia. […] Intravenous beta-blockade and non-dihydropyridine calcium channel blockers are the first choice drugs for treating hemodynamically stable patients with idiopathic ventricular tachycardia. […] Intravenous beta-blockade is the mainstay of treatment in hemodynamically stable patients with VT secondary to underlying cardiac channelopathies. […] […] All patients with structural heart disease and left ventricular systolic dysfunction should be offered guidelines-directed medical therapy for heart failure. Patients with ischemic cardiomyopathy who survive sudden cardiac arrest due to ventricular tachycardia, or experience hemodynamically unstable or stable sustained ventricular tachycardia, should have an implantable cardiac defibrillator (ICD) placed if their estimated meaningful survival is greater than one year. […] Catheter ablation has been proven as an effective treatment option for patients with drug-refractory ventricular tachycardia. It is recommended in a select group of patients with ischemic cardiomyopathy who continue to have sustained VT on antiarrhythmic drugs or are intolerant of amiodarone or other antiarrhythmic medications.

• #12 Ventricular Tachycardia Treatment & Management: Approach Considerations, Initial Supportive Management, Cardioversion in Acute Ventricular Tachycardia

  https://emedicine.medscape.com/article/159075-treatment

  Sustained ventricular tachycardia (VT) may lead to hemodynamic collapse. Consequently, these patients require urgent conversion to sinus rhythm. The strategy for conversion depends on whether the patient is hemodynamically stable or unstable. […] Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion, usually at a starting energy dose of 100 J (monophasic; comparable biphasic recommendations are not currently available). Unstable polymorphic VT is treated with immediate defibrillation. […] In stable patients with monomorphic VT and normal LV function, restoration of sinus rhythm is typically achieved with intravenous (IV) procainamide, amiodarone, or sotalol. […] If medical therapy is unsuccessful, synchronized cardioversion (50-200 J monophasic) following sedation is appropriate.

• #13 Ventricular Tachycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532954/

  […] In patients with structural heart disease and hemodynamically stable ventricular tachycardia, intravenous procainamide, amiodarone, and sotalol (depending on availability) are recommended for the acute treatment of ventricular tachycardia. […] Intravenous beta-blockade and non-dihydropyridine calcium channel blockers are the first choice drugs for treating hemodynamically stable patients with idiopathic ventricular tachycardia. […] Intravenous beta-blockade is the mainstay of treatment in hemodynamically stable patients with VT secondary to underlying cardiac channelopathies. […] […] All patients with structural heart disease and left ventricular systolic dysfunction should be offered guidelines-directed medical therapy for heart failure. Patients with ischemic cardiomyopathy who survive sudden cardiac arrest due to ventricular tachycardia, or experience hemodynamically unstable or stable sustained ventricular tachycardia, should have an implantable cardiac defibrillator (ICD) placed if their estimated meaningful survival is greater than one year. […] Catheter ablation has been proven as an effective treatment option for patients with drug-refractory ventricular tachycardia. It is recommended in a select group of patients with ischemic cardiomyopathy who continue to have sustained VT on antiarrhythmic drugs or are intolerant of amiodarone or other antiarrhythmic medications.

• #14 Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment – The Cardiovascular

  https://ecgwaves.com/topic/ventricular-tachycardia-vt-ecg-treatment-causes-management/

  If antiarrhythmic agents fail to treat monomorphic VT, catheter ablation should be considered as an effective alternative. […] Administration of prophylactic lidocaine upon return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is associated with less recurrent VF/VT arrest. […] First-line therapy: beta-blockers, amiodarone, lidocaine, procainamide. […] Second-line therapy: Sotalol. […] First-line therapy: Beta-blockers are usually effective in treating idiopathic VT. […] First-line therapy: Beta-blockers. […] First-line therapy: Beta-blockers, amiodarone (150-300 mg i.v. bolus over 10 minutes), or lidocaine (1 mg/kg i.v bolus over 5 minutes). […] Amiodarone should be considered if beta-blockers and revascularization are insufficient to eliminate the arrhythmias.

• #15 Ventricular Tachycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532954/

  […] Cardiac arrest is the life-threatening presentation of ventricular tachycardia. Patients presenting with cardiac arrest secondary to ventricular tachycardia should be resuscitated and managed according to the advanced life support (ACLS) algorithm. In the absence of a cardiac arrest, patients with hemodynamically unstable ventricular tachycardia are managed with direct current cardioversion. […] In hemodynamically unstable patients, intravenous amiodarone should be used to maintain the sinus rhythm if ventricular tachycardia does not respond to direct current cardioversion or VT recurs after successful cardioversion. All hemodynamically unstable patients with myocardial infarction/ischemia-induced ventricular tachycardia should undergo coronary angiogram followed by revascularization.

• #16 Ventricular Tachycardia Medication: Antiarrhythmics, Class IA, Antiarrhythmics, Class IB, Antiarrhythmics, Class IC, Antiarrhythmics, Class III, Beta Blockers, Beta1-Selective, Electrolytes, Alkalinizing Agents, Alpha-/Beta-Adrenergic Agonists, Vasopressi

  https://emedicine.medscape.com/article/159075-medication

  The mainstays of treatment for clinically stable ventricular tachycardia (VT) are the various antiarrhythmic drugs. In the United States, the intravenous (IV) antiarrhythmic drugs available for suppression of acute monomorphic VT are limited to procainamide, lidocaine, and amiodarone, along with the beta-adrenergic blocking agents metoprolol, esmolol, and propranolol. Bretylium is no longer available. […] IV administration of antiarrhythmics is used for the suppression of acute VT. These agents alter the electrophysiologic mechanisms that are responsible for the arrhythmia. Amiodarone is the drug of choice for acute VT refractory to cardioversion shock. After recovery, oral medications are used for long-term suppression of recurrent VT. Current evidence favors class III antiarrhythmic drugs over class I drugs. […] Amiodarone is the drug of choice for the treatment of hemodynamically unstable VT that is refractory to other antiarrhythmic agents.

• #17 Ventricular Tachycardia Medication: Antiarrhythmics, Class IA, Antiarrhythmics, Class IB, Antiarrhythmics, Class IC, Antiarrhythmics, Class III, Beta Blockers, Beta1-Selective, Electrolytes, Alkalinizing Agents, Alpha-/Beta-Adrenergic Agonists, Vasopressi

  https://emedicine.medscape.com/article/159075-medication

  The mainstays of treatment for clinically stable ventricular tachycardia (VT) are the various antiarrhythmic drugs. In the United States, the intravenous (IV) antiarrhythmic drugs available for suppression of acute monomorphic VT are limited to procainamide, lidocaine, and amiodarone, along with the beta-adrenergic blocking agents metoprolol, esmolol, and propranolol. Bretylium is no longer available. […] IV administration of antiarrhythmics is used for the suppression of acute VT. These agents alter the electrophysiologic mechanisms that are responsible for the arrhythmia. Amiodarone is the drug of choice for acute VT refractory to cardioversion shock. After recovery, oral medications are used for long-term suppression of recurrent VT. Current evidence favors class III antiarrhythmic drugs over class I drugs. […] Amiodarone is the drug of choice for the treatment of hemodynamically unstable VT that is refractory to other antiarrhythmic agents.

• #18 Ventricular Tachycardias: Symptoms and Treatment | Doctor

  https://patient.info/doctor/ventricular-tachycardias

  Stable VT patients do not experience symptoms of haemodynamic decompensation. […] Therefore, stable VT should be treated with lidocaine or timely cardioversion if lidocaine is ineffective. […] The evidence on percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for VT is limited but has shown that the procedure is effective in carefully selected patients and raises no major safety issues.5 […] After the initial dose of amiodarone 300 mg IV, it may be followed by an infusion of 900 mg over 24 hours.4 […] National Institute for Health and Care Excellence (NICE) guidance recommends that ICDs should be considered for patients in the following categories:6 […] ICDs, cardiac resynchronisation therapy (CRT) with defibrillator (CRTD) or CRT with pacing (CRTP) may be considered as choices for people with heart failure who have left ventricular dysfunction with an LVEF of 35% or less.

• #19 Ventricular tachycardia – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/ventricular-tachycardia/

  IV amiodarone is useful in hemodynamically tenuous or unstable VT as it has minimal hemodynamic effect and a slower onset of action. […] IV procainamide may be considered in patients with monomorphic VT who are hemodynamically stable, as it rapidly slows and terminates VT but can cause hypotension in up to 20% of patients. […] IV Lidocaine may be helpful for sustained monomorphic VT in the setting of cardiac ischemia or infarction. […] Recurrent or incessant polymorphic VT due to acute myocardial ischemia requires urgent revascularization. […] IV beta-blockers are useful in recurrent polymorphic VT, especially if there is concern for ischemia. […] IV amiodarone can be used in recurrent polymorphic VT as long as there is no concern for underlying congenital or acquired prolonged QT intervals.

• #20 Ventricular tachycardia – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/ventricular-tachycardia/

  IV amiodarone is useful in hemodynamically tenuous or unstable VT as it has minimal hemodynamic effect and a slower onset of action. […] IV procainamide may be considered in patients with monomorphic VT who are hemodynamically stable, as it rapidly slows and terminates VT but can cause hypotension in up to 20% of patients. […] IV Lidocaine may be helpful for sustained monomorphic VT in the setting of cardiac ischemia or infarction. […] Recurrent or incessant polymorphic VT due to acute myocardial ischemia requires urgent revascularization. […] IV beta-blockers are useful in recurrent polymorphic VT, especially if there is concern for ischemia. […] IV amiodarone can be used in recurrent polymorphic VT as long as there is no concern for underlying congenital or acquired prolonged QT intervals.

• #21 Ventricular Tachycardia – Core EM

  https://coreem.net/core/ventricular-tachycardia/

  Definition: A wide-complex (QRS complex 120 msec) tachydysrhythmia that originates within or below the bundle of His. […] Immediate Management: The primary goal is to convert the patient back to sinus rhythm and then, to address the underlying cause (most likely ischemic heart disease) […] Directed Management […] Electrical Cardioversion: Synchronized cardioversion is indicated for unstable patients with VT who have a pulse. […] Synchronized cardioversion should also be strongly considered in stable patients with VT as it is safe and both more effective and more rapid than chemical cardioversion. […] Chemical Cardioversion: Lidocaine, Class 1B antidysrhythmic agent. […] The recent PROCAMIO study demonstrated that procainamide had a lower risk of major cardiac adverse events and was more successful at terminating wide complex tachydysrhythmias.

• #22 Ventricular Tachycardia • LITFL • CCC Cardiology

  https://litfl.com/ventricular-tachycardia/

  MANAGEMENT […] PULSELESS […] ACLS protocol […] Immediate unsynchronised defibrillation […] CPR with minimal interruption (30:2, with 2 minute cycles) […] Intubation […] O2 […] IV access […] Adrenaline 1mg Q3min […] Amiodarone 300mg (following 3rd shock) […] Exclude reversible causes (4 Hs and Ts) […] […] […] CLINICALLY COMPROMISED […] Haemodynamically unstable, chest pain, ischaemia, heart failure, VR 150/min – synchronised shock (x 3) […] O2 […] IV access […] Rapid exclusion of reversible factors (wire, PA catheter in RV, hypoK+ or Mg2+) […] Amiodarone 5mg/kg – infusion […] Synchronised DC Shock (50J Bi, 100 Mono) […] Consider:- procainamide 50mg/min- lignocaine 1mg/kg- sotalol 1mg/kg […] Repeat DC Shock (150 Bi, 360 Mono) […] Overdrive pacing […] […]

• #23 Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment – The Cardiovascular

  https://ecgwaves.com/topic/ventricular-tachycardia-vt-ecg-treatment-causes-management/

  Lidocaine is as effective as amiodarone and should be preferred in patients with hypotension. […] Magnesium sulfate 2 g i.v, regardless of serum magnesium level. […] Torsade de pointes occurring during bradycardia or long pauses can be counteracted by increasing the heart rate. […] Beta-blockers reduce the risk of sudden cardiac arrest in individuals with heart failure. […] Amiodarone is the first-line therapy only if an ICD is not available. […] Ventricular arrhythmias in arrhythmogenic cardiomyopathies and channelopathies are mostly treated with antiarrhythmic agents.

• #24 Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment – The Cardiovascular

  https://ecgwaves.com/topic/ventricular-tachycardia-vt-ecg-treatment-causes-management/

  Lidocaine is as effective as amiodarone and should be preferred in patients with hypotension. […] Magnesium sulfate 2 g i.v, regardless of serum magnesium level. […] Torsade de pointes occurring during bradycardia or long pauses can be counteracted by increasing the heart rate. […] Beta-blockers reduce the risk of sudden cardiac arrest in individuals with heart failure. […] Amiodarone is the first-line therapy only if an ICD is not available. […] Ventricular arrhythmias in arrhythmogenic cardiomyopathies and channelopathies are mostly treated with antiarrhythmic agents.

• #25 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  A person with pulseless VT should be treated following current ACLS guidelines. This includes high-energy unsynchronized defibrillation, at either 360J for a monophasic defibrillator or 200J for a biphasic defibrillator. Additionally, epinephrine and other antiarrythmatics such as lidocaine may be administered to terminate the rhythm. […] For those who are stable with a monomorphic waveform the medications procainamide or sotalol may be used and are more effective than lidocaine. Evidence does not show that amiodarone is better than procainamide. […] Long-term anti-arrhythmic therapy may be indicated to prevent recurrence of VT. Beta-blockers and a number of class III anti-arrhythmics are commonly used, such as the beta-blockers carvedilol, metoprolol, and bisoprolol, and the Potassium-Channel-Blockers amiodarone, dronedarone, bretylium, sotalol, ibutilide, and dofetilide. Angiotensin-converting-enzyme (ACE) inhibitors and aldosterone antagonists are also sometimes used in this setting.

• #26 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  A person with pulseless VT should be treated following current ACLS guidelines. This includes high-energy unsynchronized defibrillation, at either 360J for a monophasic defibrillator or 200J for a biphasic defibrillator. Additionally, epinephrine and other antiarrythmatics such as lidocaine may be administered to terminate the rhythm. […] For those who are stable with a monomorphic waveform the medications procainamide or sotalol may be used and are more effective than lidocaine. Evidence does not show that amiodarone is better than procainamide. […] Long-term anti-arrhythmic therapy may be indicated to prevent recurrence of VT. Beta-blockers and a number of class III anti-arrhythmics are commonly used, such as the beta-blockers carvedilol, metoprolol, and bisoprolol, and the Potassium-Channel-Blockers amiodarone, dronedarone, bretylium, sotalol, ibutilide, and dofetilide. Angiotensin-converting-enzyme (ACE) inhibitors and aldosterone antagonists are also sometimes used in this setting.

• #27 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  In patients with SHD and VT, antiarrhythmic drugs can be used in conjunction with ICD programming to minimise shocks. […] Catheter ablation of VT was first described in the 1980s, and has since gained an increasingly prominent role in the management of many types of VT. […] The impact of catheter ablation has been studied in a variety of causes of VT. […] In idiopathic VT (outflow tract, fascicular, papillary), ablation can be undertaken in patients intolerant of or refusing medical therapy, in cases where VT has led to reduction in LVEF, or where outflow tract PVCs are found to trigger malignant arrhythmias; procedural success rate is high, with low risk. […] In ischaemic cardiomyopathy, multiple small-scale trials have demonstrated reductions in ICD therapies and greater freedom from VT for patients undergoing ablation and ICD implantation compared to ICD implantation alone.

• #28 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  A person with pulseless VT should be treated following current ACLS guidelines. This includes high-energy unsynchronized defibrillation, at either 360J for a monophasic defibrillator or 200J for a biphasic defibrillator. Additionally, epinephrine and other antiarrythmatics such as lidocaine may be administered to terminate the rhythm. […] For those who are stable with a monomorphic waveform the medications procainamide or sotalol may be used and are more effective than lidocaine. Evidence does not show that amiodarone is better than procainamide. […] Long-term anti-arrhythmic therapy may be indicated to prevent recurrence of VT. Beta-blockers and a number of class III anti-arrhythmics are commonly used, such as the beta-blockers carvedilol, metoprolol, and bisoprolol, and the Potassium-Channel-Blockers amiodarone, dronedarone, bretylium, sotalol, ibutilide, and dofetilide. Angiotensin-converting-enzyme (ACE) inhibitors and aldosterone antagonists are also sometimes used in this setting.

• #29 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  A person with pulseless VT should be treated following current ACLS guidelines. This includes high-energy unsynchronized defibrillation, at either 360J for a monophasic defibrillator or 200J for a biphasic defibrillator. Additionally, epinephrine and other antiarrythmatics such as lidocaine may be administered to terminate the rhythm. […] For those who are stable with a monomorphic waveform the medications procainamide or sotalol may be used and are more effective than lidocaine. Evidence does not show that amiodarone is better than procainamide. […] Long-term anti-arrhythmic therapy may be indicated to prevent recurrence of VT. Beta-blockers and a number of class III anti-arrhythmics are commonly used, such as the beta-blockers carvedilol, metoprolol, and bisoprolol, and the Potassium-Channel-Blockers amiodarone, dronedarone, bretylium, sotalol, ibutilide, and dofetilide. Angiotensin-converting-enzyme (ACE) inhibitors and aldosterone antagonists are also sometimes used in this setting.

• #30 Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment – The Cardiovascular

  https://ecgwaves.com/topic/ventricular-tachycardia-vt-ecg-treatment-causes-management/

  Ventricular tachycardia is a highly nuanced arrhythmia that originates in the ventricles. […] Regardless of etiology and ECG, ventricular tachycardia is always a potentially life-threatening arrhythmia that requires immediate attention. […] All healthcare providers, regardless of profession, must be able to diagnose ventricular tachycardia. […] The risk of degeneration to ventricular fibrillation (VF) is substantially higher in polymorphic VT, as compared with monomorphic VT. […] Always search for and correct reversible causes of ventricular arrhythmias. […] In the context of antiarrhythmic drugs, structural heart disease (SHD) is defined as ischemic heart disease, valvular heart disease, congenital heart disease, ventricular hypertrophy or myocardial disease. […] While several antiarrhythmic drug classes are available for emergency treatment of VT/VF in these patients, long-term treatment is limited mostly to amiodarone, beta-blockers or sotalol.

• #31 Ventricular tachycardia – Wikipedia

  https://en.wikipedia.org/wiki/Ventricular_tachycardia

  An ICD (implantable cardioverter defibrillator) is more effective than drug therapy for prevention of sudden cardiac death due to VT and VF, but does not prevent these rhythms from happening. […] Catheter ablation is a potentially definitive treatment option for those with recurrent VT. Remote magnetic navigation is one effective method to do the procedure.

• #32 Ventricular Tachycardia (VT) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/ventricular-tachycardia-vt

  Stable sustained VT can be treated with intravenous class I or class III antiarrhythmics. […] Right and left ventricular outflow tract ventricular tachycardias (RVOT-VT and LVOT-VT) respond to IV adenosine. Verapamil-sensitive left fascicular ventricular tachycardia responds to IV verapamil. […] The primary goal is preventing sudden death, rather than simply suppressing the arrhythmia. It is best accomplished by use of an implantable cardioverter-defibrillator (ICD). […] In the absence of a transient or reversible cause, patients who have had an episode of sustained VT typically require an ICD. […] Most patients with sustained VT and a significant structural heart disorder should also receive a beta-blocker. […] When prevention of VT is important (usually in patients who have an ICD and are having frequent episodes of VT), antiarrhythmics or transcatheter or surgical ablation of the arrhythmogenic substrate is required.

• #33 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Recently, catheter ablation has gained a prominent and earlier role in the management of patients with VT. […] Caring for patients undergoing catheter ablation of VT in dedicated units with integrated multidisciplinary care has been shown to lead to improved outcomes. […] In patients with ventricular arrhythmias in the context of SHD (i.e. the secondary prevention population), ICD implantation is indicated in almost all cases. […] While the ICD is effective in preventing sudden cardiac death due to VT or ventricular fibrillation in patients with heart failure, it does not prevent occurrence of VT, and many patients with an ICD will present with one or multiple shocks. […] In patients with recurrent ICD shocks, reprogramming of ICDs by the EP team can help to minimise shocks. […] The use of overdrive or anti-tachycardia pacing (ATP) to terminate haemodynamically stable VTs before shocks has been shown to be effective.

• #34 Ventricular Tachycardias: Symptoms and Treatment | Doctor

  https://patient.info/doctor/ventricular-tachycardias

  Stable VT patients do not experience symptoms of haemodynamic decompensation. […] Therefore, stable VT should be treated with lidocaine or timely cardioversion if lidocaine is ineffective. […] The evidence on percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for VT is limited but has shown that the procedure is effective in carefully selected patients and raises no major safety issues.5 […] After the initial dose of amiodarone 300 mg IV, it may be followed by an infusion of 900 mg over 24 hours.4 […] National Institute for Health and Care Excellence (NICE) guidance recommends that ICDs should be considered for patients in the following categories:6 […] ICDs, cardiac resynchronisation therapy (CRT) with defibrillator (CRTD) or CRT with pacing (CRTP) may be considered as choices for people with heart failure who have left ventricular dysfunction with an LVEF of 35% or less.

• #35 Ventricular Tachycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532954/

  […] In patients with structural heart disease and hemodynamically stable ventricular tachycardia, intravenous procainamide, amiodarone, and sotalol (depending on availability) are recommended for the acute treatment of ventricular tachycardia. […] Intravenous beta-blockade and non-dihydropyridine calcium channel blockers are the first choice drugs for treating hemodynamically stable patients with idiopathic ventricular tachycardia. […] Intravenous beta-blockade is the mainstay of treatment in hemodynamically stable patients with VT secondary to underlying cardiac channelopathies. […] […] All patients with structural heart disease and left ventricular systolic dysfunction should be offered guidelines-directed medical therapy for heart failure. Patients with ischemic cardiomyopathy who survive sudden cardiac arrest due to ventricular tachycardia, or experience hemodynamically unstable or stable sustained ventricular tachycardia, should have an implantable cardiac defibrillator (ICD) placed if their estimated meaningful survival is greater than one year. […] Catheter ablation has been proven as an effective treatment option for patients with drug-refractory ventricular tachycardia. It is recommended in a select group of patients with ischemic cardiomyopathy who continue to have sustained VT on antiarrhythmic drugs or are intolerant of amiodarone or other antiarrhythmic medications.

• #36 Ventricular tachycardia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/diagnosis-treatment/drc-20355144

  Some people with tachycardia need a device to help control the heartbeat and reset the heart rhythm. […] Your care team may suggest this device if you have a high risk of dangerously fast or irregular heartbeats in the lower heart chambers. An ICD is placed under the skin near the collarbone. It continuously checks the heart rhythm. If the device finds an irregular heartbeat, it sends a shock to reset the heart’s rhythm. […] If slow heartbeats don’t have a cause that can be fixed, a pacemaker may be needed. A pacemaker is a small device that’s placed in the chest to help control the heartbeat. When it finds an irregular heartbeat, it sends an electrical signal that helps correct the heart’s rhythm.

• #37 Ventricular Tachycardia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/ventricular-tachycardia

  An implantable cardioverter defibrillator is a device for people who are prone to life-threatening rapid heart rhythms. It is slightly larger than a pacemaker and usually is implanted beneath the skin below the collarbone. It is connected to a defibrillation/pace wire(s) positioned inside the heart via a vein. It has the capability of delivering an electric shock to the heart when it determines the heart rate is too fast. It also is capable of pacing or stimulating the heart when it is going too slow. […] The U.S. Food and Drug Administration (FDA) recently approved the first of a new type of pacemaker that paces both ventricles of the heart to coordinate their contractions and improve their pumping ability.

• #38 Ventricular tachycardia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/diagnosis-treatment/drc-20355144

  An ICD controls the heartbeat by delivering shocks to the heart when the device detects an irregular heartbeat. […] A subcutaneous implantable cardioverter-defibrillator (S-ICD) is a less invasive alternative to a traditional ICD. The S-ICD device is placed under the skin at the side of the chest below the armpit. It connects it to a sensor that runs along the breastbone. […] A surgery or procedure may be needed to control or prevent episodes of tachycardia. […] Cardioversion uses quick, low-energy shocks to reset the heart rhythm. It’s also possible to do cardioversion with medicines. A shock also can be delivered to the heart using an automated external defibrillator (AED). […] In this treatment, the doctor places one or more catheters into blood vessels to the heart. Sensors at the catheter tips use heat or cold energy to create tiny scars in your heart. The scars block irregular heart signals and restore the heartbeat.

• #39 Ventricular Tachycardia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/ventricular-tachycardia

  Ventricular tachycardia is a fast heart rate that starts in the ventricles, the heart’s lower chambers. It usually results from serious heart disease and often requires prompt or emergency treatment. […] Depending on the type and severity of your arrhythmia, and the results of various tests including the electrophysiology study, there are several treatment options. You and your doctor will decide which one is right for you. […] Certain anti-arrhythmic drugs change the electrical signals in the heart and help prevent abnormal sites from starting irregular or rapid heart rhythms. […] A technique pioneered at UCSF, radiofrequency catheter ablation destroys or disrupts parts of the electrical pathways causing the arrhythmias, providing relief for patients who may not have responded well to medications, or who would rather not or can’t take medications.

• #40 Ventricular Tachycardia Treatment & Management: Approach Considerations, Initial Supportive Management, Cardioversion in Acute Ventricular Tachycardia

  https://emedicine.medscape.com/article/159075-treatment

  Catheter ablation: Effective, but recurrent VT is not uncommon. […] Antiarrhythmic drugs have traditionally been the mainstays of treatment for clinically stable patients with VT. However, some patients experience unacceptable side effects or frequent recurrence of VT with drug therapy. […] In patients with idiopathic VT (associated with structurally normal hearts), medications are often avoided entirely through the use of curative catheter-based ablation. […] Patients with congenital long QT syndrome and catecholamine polymorphic VT have been linked to sudden cardiac death. Patients with these disorders are managed with a combination of genetic typing, beta blockers, lifestyle modification and, in selected cases, ICD placement. […] Catheter ablation is used early in patients with idiopathic monomorphic VT (ie, VT in a structurally normal heart arising from a focal source) that is resistant to drug therapy, as well as in those who are drug-intolerant or do not wish to have long-term drug therapy.

• #41 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  In patients with SHD and VT, antiarrhythmic drugs can be used in conjunction with ICD programming to minimise shocks. […] Catheter ablation of VT was first described in the 1980s, and has since gained an increasingly prominent role in the management of many types of VT. […] The impact of catheter ablation has been studied in a variety of causes of VT. […] In idiopathic VT (outflow tract, fascicular, papillary), ablation can be undertaken in patients intolerant of or refusing medical therapy, in cases where VT has led to reduction in LVEF, or where outflow tract PVCs are found to trigger malignant arrhythmias; procedural success rate is high, with low risk. […] In ischaemic cardiomyopathy, multiple small-scale trials have demonstrated reductions in ICD therapies and greater freedom from VT for patients undergoing ablation and ICD implantation compared to ICD implantation alone.

• #42 Ventricular Tachycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532954/

  […] In patients with structural heart disease and hemodynamically stable ventricular tachycardia, intravenous procainamide, amiodarone, and sotalol (depending on availability) are recommended for the acute treatment of ventricular tachycardia. […] Intravenous beta-blockade and non-dihydropyridine calcium channel blockers are the first choice drugs for treating hemodynamically stable patients with idiopathic ventricular tachycardia. […] Intravenous beta-blockade is the mainstay of treatment in hemodynamically stable patients with VT secondary to underlying cardiac channelopathies. […] […] All patients with structural heart disease and left ventricular systolic dysfunction should be offered guidelines-directed medical therapy for heart failure. Patients with ischemic cardiomyopathy who survive sudden cardiac arrest due to ventricular tachycardia, or experience hemodynamically unstable or stable sustained ventricular tachycardia, should have an implantable cardiac defibrillator (ICD) placed if their estimated meaningful survival is greater than one year. […] Catheter ablation has been proven as an effective treatment option for patients with drug-refractory ventricular tachycardia. It is recommended in a select group of patients with ischemic cardiomyopathy who continue to have sustained VT on antiarrhythmic drugs or are intolerant of amiodarone or other antiarrhythmic medications.

• #43 Ventricular Tachycardia Treatment & Management: Approach Considerations, Initial Supportive Management, Cardioversion in Acute Ventricular Tachycardia

  https://emedicine.medscape.com/article/159075-treatment

  Catheter ablation may also be used in patients with cardiomyopathy. The goal in these cases is to reduce the arrhythmia burden and thereby minimize the number of ICD shocks. […] In patients with structurally normal hearts, the most common form of VT arises from the right ventricular outflow tract (RVOT). The typical outflow tract ectopic beat shows a positive QRS axis in the inferior leads.

• #44 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Recently, catheter ablation has gained a prominent and earlier role in the management of patients with VT. […] Caring for patients undergoing catheter ablation of VT in dedicated units with integrated multidisciplinary care has been shown to lead to improved outcomes. […] In patients with ventricular arrhythmias in the context of SHD (i.e. the secondary prevention population), ICD implantation is indicated in almost all cases. […] While the ICD is effective in preventing sudden cardiac death due to VT or ventricular fibrillation in patients with heart failure, it does not prevent occurrence of VT, and many patients with an ICD will present with one or multiple shocks. […] In patients with recurrent ICD shocks, reprogramming of ICDs by the EP team can help to minimise shocks. […] The use of overdrive or anti-tachycardia pacing (ATP) to terminate haemodynamically stable VTs before shocks has been shown to be effective.

• #45 Ventricular tachycardia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/diagnosis-treatment/drc-20355144

  An ICD controls the heartbeat by delivering shocks to the heart when the device detects an irregular heartbeat. […] A subcutaneous implantable cardioverter-defibrillator (S-ICD) is a less invasive alternative to a traditional ICD. The S-ICD device is placed under the skin at the side of the chest below the armpit. It connects it to a sensor that runs along the breastbone. […] A surgery or procedure may be needed to control or prevent episodes of tachycardia. […] Cardioversion uses quick, low-energy shocks to reset the heart rhythm. It’s also possible to do cardioversion with medicines. A shock also can be delivered to the heart using an automated external defibrillator (AED). […] In this treatment, the doctor places one or more catheters into blood vessels to the heart. Sensors at the catheter tips use heat or cold energy to create tiny scars in your heart. The scars block irregular heart signals and restore the heartbeat.

• #46 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  In patients with SHD and VT, antiarrhythmic drugs can be used in conjunction with ICD programming to minimise shocks. […] Catheter ablation of VT was first described in the 1980s, and has since gained an increasingly prominent role in the management of many types of VT. […] The impact of catheter ablation has been studied in a variety of causes of VT. […] In idiopathic VT (outflow tract, fascicular, papillary), ablation can be undertaken in patients intolerant of or refusing medical therapy, in cases where VT has led to reduction in LVEF, or where outflow tract PVCs are found to trigger malignant arrhythmias; procedural success rate is high, with low risk. […] In ischaemic cardiomyopathy, multiple small-scale trials have demonstrated reductions in ICD therapies and greater freedom from VT for patients undergoing ablation and ICD implantation compared to ICD implantation alone.

• #47 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  In patients with SHD and VT, antiarrhythmic drugs can be used in conjunction with ICD programming to minimise shocks. […] Catheter ablation of VT was first described in the 1980s, and has since gained an increasingly prominent role in the management of many types of VT. […] The impact of catheter ablation has been studied in a variety of causes of VT. […] In idiopathic VT (outflow tract, fascicular, papillary), ablation can be undertaken in patients intolerant of or refusing medical therapy, in cases where VT has led to reduction in LVEF, or where outflow tract PVCs are found to trigger malignant arrhythmias; procedural success rate is high, with low risk. […] In ischaemic cardiomyopathy, multiple small-scale trials have demonstrated reductions in ICD therapies and greater freedom from VT for patients undergoing ablation and ICD implantation compared to ICD implantation alone.

• #48 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  In the recent Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (VANISH) trial, catheter ablation was also found to be superior to escalation of antiarrhythmic therapy in reducing the incidence of a composite primary endpoint of death, VT storm and appropriate ICD shocks. […] The trend towards earlier ablation appears to be supported by improved outcomes in the literature: in one retrospective study of ischaemic and non-ischaemic cardiomyopathy, ablation within 30 days of first documented VT was associated with significantly higher rates of acute procedural success and freedom from VT recurrence. […] Catheter ablation in the setting of VT storm has been shown to suppress acute recurrence and stabilise the patient in the short term, even if the procedure is not completely successful; in longer term follow-up, procedural success is associated with reduced VT storm and improved survival.

• #49 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  In the recent Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (VANISH) trial, catheter ablation was also found to be superior to escalation of antiarrhythmic therapy in reducing the incidence of a composite primary endpoint of death, VT storm and appropriate ICD shocks. […] The trend towards earlier ablation appears to be supported by improved outcomes in the literature: in one retrospective study of ischaemic and non-ischaemic cardiomyopathy, ablation within 30 days of first documented VT was associated with significantly higher rates of acute procedural success and freedom from VT recurrence. […] Catheter ablation in the setting of VT storm has been shown to suppress acute recurrence and stabilise the patient in the short term, even if the procedure is not completely successful; in longer term follow-up, procedural success is associated with reduced VT storm and improved survival.

• #50 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Epicardial ablation is a safe procedure with low complication rates. […] Endo-epicardial catheter ablation resulted in a VT recurrence rate of 34.1%, in comparison to a rate of up to 50% with the standard endocardial approach. […] Transcoronary alcohol ablation has emerged to approach deep intramyocardial substrate in patients not amenable to endo-epicardial catheter ablation. […] Bipolar ablation between two ablation catheters located on either position of the septum from both ventricles improves lesion transmurality because it depends less on catheter contact and alignment. […] Cardiac sympathetic denervation surgery has been proven to be useful for the management of congenital long QT syndrome and catecholaminergic polymorphic VT. […] Renal sympathetic denervation is not currently recognized as an ideal or approved VT treatment method.

• #51 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of ventricular tachycardia (VT) treatment management, but both treatments have limited efficacy and important adverse effects. […] Catheter ablation for cardiomyopathic (scar-related) VT is associated with recurrence rates as high as 50% at 6 mo. […] When the VT substrate manifests, anti-arrhythmic drug treatment or catheter ablation are the current choices to reduce VT episodes. […] Catheter ablation and antiarrhythmic drug therapy though, are also limited by incomplete efficacy, unfavorable side effects, and procedural risk. […] Epicardial ablation has emerged as a potential alternative ablation strategy in order to increase the success rate in complex substrates and to eliminate VT in patients with different cardiomyopathies and more recently in patients with Brugada syndrome.

• #52 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Epicardial ablation is a safe procedure with low complication rates. […] Endo-epicardial catheter ablation resulted in a VT recurrence rate of 34.1%, in comparison to a rate of up to 50% with the standard endocardial approach. […] Transcoronary alcohol ablation has emerged to approach deep intramyocardial substrate in patients not amenable to endo-epicardial catheter ablation. […] Bipolar ablation between two ablation catheters located on either position of the septum from both ventricles improves lesion transmurality because it depends less on catheter contact and alignment. […] Cardiac sympathetic denervation surgery has been proven to be useful for the management of congenital long QT syndrome and catecholaminergic polymorphic VT. […] Renal sympathetic denervation is not currently recognized as an ideal or approved VT treatment method.

• #53 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Epicardial ablation is a safe procedure with low complication rates. […] Endo-epicardial catheter ablation resulted in a VT recurrence rate of 34.1%, in comparison to a rate of up to 50% with the standard endocardial approach. […] Transcoronary alcohol ablation has emerged to approach deep intramyocardial substrate in patients not amenable to endo-epicardial catheter ablation. […] Bipolar ablation between two ablation catheters located on either position of the septum from both ventricles improves lesion transmurality because it depends less on catheter contact and alignment. […] Cardiac sympathetic denervation surgery has been proven to be useful for the management of congenital long QT syndrome and catecholaminergic polymorphic VT. […] Renal sympathetic denervation is not currently recognized as an ideal or approved VT treatment method.

• #54 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Epicardial ablation is a safe procedure with low complication rates. […] Endo-epicardial catheter ablation resulted in a VT recurrence rate of 34.1%, in comparison to a rate of up to 50% with the standard endocardial approach. […] Transcoronary alcohol ablation has emerged to approach deep intramyocardial substrate in patients not amenable to endo-epicardial catheter ablation. […] Bipolar ablation between two ablation catheters located on either position of the septum from both ventricles improves lesion transmurality because it depends less on catheter contact and alignment. […] Cardiac sympathetic denervation surgery has been proven to be useful for the management of congenital long QT syndrome and catecholaminergic polymorphic VT. […] Renal sympathetic denervation is not currently recognized as an ideal or approved VT treatment method.

• #55 Ventricular Arrhythmia Program | Valley Health System

  https://www.valleyhealth.com/services/ventricular-arrhythmia-program

  In cases where the heart has become damaged or scar tissue has formed due to previous heart attacks or other cardiac conditions, VT can be life-threatening. This level of disease often necessitates treatment with an implantable cardioverter-defibrillator (ICD). […] A minimally invasive catheter ablation procedure aims to destroy the abnormal heart tissue (scar tissue) responsible for VT, making it the most effective method for reducing or eliminating VT episodes. […] Alcohol ablation is a specialized procedure used when VT is caused by scarring in the heart, often due to previous heart attacks. […] Cardiac sympathectomy is a surgical procedure used to treat VT, especially in cases where other treatments like medication or ablation have not been successful. […] Some patients diagnosed with VT those with additional medical conditions may continue to experience arrhythmia episodes even while on medication.

• #56 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Epicardial ablation is a safe procedure with low complication rates. […] Endo-epicardial catheter ablation resulted in a VT recurrence rate of 34.1%, in comparison to a rate of up to 50% with the standard endocardial approach. […] Transcoronary alcohol ablation has emerged to approach deep intramyocardial substrate in patients not amenable to endo-epicardial catheter ablation. […] Bipolar ablation between two ablation catheters located on either position of the septum from both ventricles improves lesion transmurality because it depends less on catheter contact and alignment. […] Cardiac sympathetic denervation surgery has been proven to be useful for the management of congenital long QT syndrome and catecholaminergic polymorphic VT. […] Renal sympathetic denervation is not currently recognized as an ideal or approved VT treatment method.

• #57 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Epicardial ablation is a safe procedure with low complication rates. […] Endo-epicardial catheter ablation resulted in a VT recurrence rate of 34.1%, in comparison to a rate of up to 50% with the standard endocardial approach. […] Transcoronary alcohol ablation has emerged to approach deep intramyocardial substrate in patients not amenable to endo-epicardial catheter ablation. […] Bipolar ablation between two ablation catheters located on either position of the septum from both ventricles improves lesion transmurality because it depends less on catheter contact and alignment. […] Cardiac sympathetic denervation surgery has been proven to be useful for the management of congenital long QT syndrome and catecholaminergic polymorphic VT. […] Renal sympathetic denervation is not currently recognized as an ideal or approved VT treatment method.

• #58 Management of super-refractory ventricular tachycardia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-450/management-super-refractory-ventricular-tachycardia

  The authors report better rates of VT storm control with this treatment, as compared to the conventional ACLS amiodarone/lignocaine cocktail. However, there was a disturbing disparity in group mortality: of the ACLS-treated group, only 5% survived the first week, whereas of the stellate ganglion block group 67% were still alive. […] If stellate ganglion block is insufficiently aggressive for you, thoracic epidural has been used as a means of decreasing the sympathetic flow to the irritable myocardium (Bourke et al, 2010; Tung et al, 2015). Neuraxial blockade of descending sympathetic myocardial innervation is a valid therapy because the analgesia of the epidural might be as effective as the actual sympathetic ablation. If one cannot feel one’s chest wall, being cardioverted loses much of its fear factor.

• #59 Management of super-refractory ventricular tachycardia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-450/management-super-refractory-ventricular-tachycardia

  Sodium bicarbonate is a well-known solution to the QRS widening problem in acute tricyclic overdose; however its use in ventricular tachycardia is less well known. Case reports exist of VT being terminated by sodium bicarbonate boluses (eg. Donovan et al, 1999), although in all these cases the arrhythmia is due to an overdose or adverse drug effect of some sort. Again, the effect probably has something to do with reduced affinity of the toxic drug for its receptor. This strategy is less likely to work in some sort of non-toxicological ischaemic VT. […] Invasive sympatholytic measures […] Beta-blockade may have some positive effect, but there are too many spare receptors, and one may need to resort to more aggressive measures. […] Stellate ganglion block has achieved successful VT storm termination in case reports, many of which end up published in anaesthetic pain medicine journals (Patel et al, 2011). Descriptions in the literature (Nademanee et al, 2000) suggests that these procedures are best performed by peripheral nerve block experts because they involve stabbing the patient in the neck with a 10cm 21g needle. The left-sided procedure is performed by the anterior paratracheal approach.

• #60 Management of super-refractory ventricular tachycardia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-450/management-super-refractory-ventricular-tachycardia

  The authors report better rates of VT storm control with this treatment, as compared to the conventional ACLS amiodarone/lignocaine cocktail. However, there was a disturbing disparity in group mortality: of the ACLS-treated group, only 5% survived the first week, whereas of the stellate ganglion block group 67% were still alive. […] If stellate ganglion block is insufficiently aggressive for you, thoracic epidural has been used as a means of decreasing the sympathetic flow to the irritable myocardium (Bourke et al, 2010; Tung et al, 2015). Neuraxial blockade of descending sympathetic myocardial innervation is a valid therapy because the analgesia of the epidural might be as effective as the actual sympathetic ablation. If one cannot feel one’s chest wall, being cardioverted loses much of its fear factor.

• #61 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Ablative radiotherapy is generally a noninvasive, outpatient method, which does not involve anesthesia. […] Catheter ablation provides efficient outcomes for sustained monomorphic VT, but certain situations, such as the existence of mural thrombus and heavy calcification, can lead to adverse results. […] Extracorporeal life support is a highly efficient bridging treatment in patients with refractory VT associated with cardiogenic shock. […] The management of patients with VT can be demanding. ICD implant led to a considerable difference in the survival of subjects with VT, but the estimate of subjects with recurrent ICD shocks is still a growing issue.

• #62 Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

  https://www.mdpi.com/2308-3425/10/4/172

  Stereotactic arrhythmia radioablation (STAR) is a specialized procedure that uses advanced imaging techniques to accurately locate and target the areas of the heart arrhythmic substrate responsible for VT. […] STAR represents an attractive alternative for patients with recurrent VT. […] While this procedure is still considered to be relatively new, initial studies have shown promising results in the treatment of VT, particularly in patients who have not responded to other forms of treatment, such as medication or traditional catheter ablation. […] However, further research is needed to fully evaluate the efficacy and safety of this technique, as well as to identify the optimal patient selection criteria and treatment protocols. […] STAR has potential risks and limitations, and there are certain patient populations that may not be suitable candidates including those with conditions such as pregnancy, prior radiation therapy, active infection or inflammation, and unstable medical conditions.

• #63 Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

  https://www.mdpi.com/2308-3425/10/4/172

  Ventricular tachycardia in patients with structural heart disease is a significant cause of morbidity and mortality. According to current guidelines, cardioverter defibrillator implantation, antiarrhythmic drugs, and catheter ablation are established therapies in the management of ventricular arrhythmias but their efficacy is limited in some cases. […] Stereotactic arrhythmia radioablation for ventricular arrhythmias was developed as bail-out therapy in patients unresponsive to traditional treatments. […] Stereotactic arrhythmia radioablation provides an alternative non-invasive and painless therapeutic strategy for the treatment of previously detected cardiac arrhythmic substrate by three-dimensional intracardiac mapping or different tools. […] Although, for now, stereotactic arrhythmia radioablation is considered an alternative palliative treatment for patients with refractory ventricular tachycardia and no other therapeutic options, this research field is currently extremely promising.

• #64 Tachycardia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/tachycardia

  Medications can be used to control your heart rhythm and prevent blood clots that can lead to a stroke. […] SBRT is an experimental treatment for ventricular tachycardia (V-Tach) that has not responded to treatment. […] At UPMC, our cardiologists are experts at managing and treating arrhythmia, including tachycardia. Your doctors will recommend the treatment that is most likely to be effective for your heart rhythm disorder while considering your lifestyle, preferences, and overall health.

• #65 Exploring Potential New Treatment for Ventricular Tachycardia

  https://www.cedars-sinai.org/newsroom/exploring-potential-new-treatment-for-ventricular-tachycardia/

  Cingolani is studying the effectiveness of a novel, noninvasive cell-based therapy to treat VT. His approach uses stem cell-derived exosomes to help regrow healthy heart muscle and prevent disruptive electrical signals. […] Current therapies for recurrent VT are not very effective and have unpleasant side effects. […] Right now, there are several treatment options, but none of them are optimal. They include medications that are not very effective and cause unpleasant side effects, an implantable cardioverter-defibrillator (or ICD) that provides an internal shock to correct the heartbeat, and a procedure called catheter ablation. […] Exosomes are tiny vesicles, secreted by cells, that naturally heal heart scars. The idea is to infuse the exosomes into diseased heart muscle that is predisposed to VT with the goal of decreasing scar tissue and preventing VT.

• #66 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. […] While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. […] A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients. […] Antiarrhythmic medications, ICD implantation and catheter ablation are the cornerstones of current VT management.

• #67 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. […] While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. […] A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients. […] Antiarrhythmic medications, ICD implantation and catheter ablation are the cornerstones of current VT management.

• #68 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. […] While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. […] A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients. […] Antiarrhythmic medications, ICD implantation and catheter ablation are the cornerstones of current VT management.

• #69 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Recently, catheter ablation has gained a prominent and earlier role in the management of patients with VT. […] Caring for patients undergoing catheter ablation of VT in dedicated units with integrated multidisciplinary care has been shown to lead to improved outcomes. […] In patients with ventricular arrhythmias in the context of SHD (i.e. the secondary prevention population), ICD implantation is indicated in almost all cases. […] While the ICD is effective in preventing sudden cardiac death due to VT or ventricular fibrillation in patients with heart failure, it does not prevent occurrence of VT, and many patients with an ICD will present with one or multiple shocks. […] In patients with recurrent ICD shocks, reprogramming of ICDs by the EP team can help to minimise shocks. […] The use of overdrive or anti-tachycardia pacing (ATP) to terminate haemodynamically stable VTs before shocks has been shown to be effective.

• #70 First-Line Therapy for Ventricular Tachycardia After MI: What’s the Best Approach?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na58104/2024/11/16/first-line-therapy-ventricular-tachycardia-after-mi-whats

  Randomized trial results favor catheter ablation over antiarrhythmic drugs as first-line therapy for recurrent VT. […] Antiarrhythmic drug therapy and catheter ablation are common strategies for reducing VT episodes, but data comparing their efficacy as first-line treatment are lacking. […] During a median follow-up of 4.3 years, the primary endpoint occurred significantly less often in the ablation group than in the drug therapy group (51% vs. 61%; hazard ratio, 0.75). […] Consequently, based on these findings, I will work with my electrophysiology colleagues to ensure that my patients with ICD placement after MI undergo catheter ablation as soon as possible after diagnosis of recurrent VT.

• #71 Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-69467-4

  The overall pooled SCD and all-cause mortality incidence in our study were 3.1% (95% CI 1.75.6) and 5.0% (95% CI 1.813.0), respectively. […] The pooled VT recurrence based on the meta-analysis of our study was 23.2%. […] Based on our results, nearly six patients out of 100 experienced complications from catheter ablation without ICD implantation. […] The lower complication rate of catheter ablation in patients with SHD and preserved LVEF, rather than ICD implantation complication rates, may lead to the catheter ablation being considered as the first-line treatment in these patients. […] After catheter ablation as the first line in patients with SHD and preserved LVEF, only 13.9% needed ICD implantation after the catheter ablation procedure. […] Based on this result and considering the high complication rates and cost of ICD implantation, it can be concluded that first-line catheter ablation of VT in patients with preserved LVEF is a proper therapeutic approach. […] Catheter ablation as the first line of VT treatment in patients with SHD and preserved LVEF appears to be a promising therapeutic option.

• #72 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Recently, catheter ablation has gained a prominent and earlier role in the management of patients with VT. […] Caring for patients undergoing catheter ablation of VT in dedicated units with integrated multidisciplinary care has been shown to lead to improved outcomes. […] In patients with ventricular arrhythmias in the context of SHD (i.e. the secondary prevention population), ICD implantation is indicated in almost all cases. […] While the ICD is effective in preventing sudden cardiac death due to VT or ventricular fibrillation in patients with heart failure, it does not prevent occurrence of VT, and many patients with an ICD will present with one or multiple shocks. […] In patients with recurrent ICD shocks, reprogramming of ICDs by the EP team can help to minimise shocks. […] The use of overdrive or anti-tachycardia pacing (ATP) to terminate haemodynamically stable VTs before shocks has been shown to be effective.

• #73 Novel approaches for the treatment of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6068734/

  Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of ventricular tachycardia (VT) treatment management, but both treatments have limited efficacy and important adverse effects. […] Catheter ablation for cardiomyopathic (scar-related) VT is associated with recurrence rates as high as 50% at 6 mo. […] When the VT substrate manifests, anti-arrhythmic drug treatment or catheter ablation are the current choices to reduce VT episodes. […] Catheter ablation and antiarrhythmic drug therapy though, are also limited by incomplete efficacy, unfavorable side effects, and procedural risk. […] Epicardial ablation has emerged as a potential alternative ablation strategy in order to increase the success rate in complex substrates and to eliminate VT in patients with different cardiomyopathies and more recently in patients with Brugada syndrome.

• #74 Team Management of the Ventricular Tachycardia Patient | AER Journal

  https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient?language_content_entity=en

  Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. […] While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. […] A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients. […] Antiarrhythmic medications, ICD implantation and catheter ablation are the cornerstones of current VT management.

• #75 First-Line Therapy for Ventricular Tachycardia After MI: What’s the Best Approach?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na58104/2024/11/16/first-line-therapy-ventricular-tachycardia-after-mi-whats

  Randomized trial results favor catheter ablation over antiarrhythmic drugs as first-line therapy for recurrent VT. […] Antiarrhythmic drug therapy and catheter ablation are common strategies for reducing VT episodes, but data comparing their efficacy as first-line treatment are lacking. […] During a median follow-up of 4.3 years, the primary endpoint occurred significantly less often in the ablation group than in the drug therapy group (51% vs. 61%; hazard ratio, 0.75). […] Consequently, based on these findings, I will work with my electrophysiology colleagues to ensure that my patients with ICD placement after MI undergo catheter ablation as soon as possible after diagnosis of recurrent VT.

• #76 Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-69467-4

  The overall pooled SCD and all-cause mortality incidence in our study were 3.1% (95% CI 1.75.6) and 5.0% (95% CI 1.813.0), respectively. […] The pooled VT recurrence based on the meta-analysis of our study was 23.2%. […] Based on our results, nearly six patients out of 100 experienced complications from catheter ablation without ICD implantation. […] The lower complication rate of catheter ablation in patients with SHD and preserved LVEF, rather than ICD implantation complication rates, may lead to the catheter ablation being considered as the first-line treatment in these patients. […] After catheter ablation as the first line in patients with SHD and preserved LVEF, only 13.9% needed ICD implantation after the catheter ablation procedure. […] Based on this result and considering the high complication rates and cost of ICD implantation, it can be concluded that first-line catheter ablation of VT in patients with preserved LVEF is a proper therapeutic approach. […] Catheter ablation as the first line of VT treatment in patients with SHD and preserved LVEF appears to be a promising therapeutic option.

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