UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Monomorphic ventricular tachycardia in the absence of apparent structural heart disease

Author
David J Callans, MD
Section Editor
Leonard I Ganz, MD, FHRS, FACC
Deputy Editor
Brian C Downey, MD, FACC

INTRODUCTION

The evaluation and management of ventricular tachyarrhythmias are uniquely challenging due to the unpredictable and potentially lethal nature of the events. When evaluating patients with ventricular tachycardia (VT) and ventricular fibrillation (VF), several initial distinctions should be made. These include:

Arrhythmia duration – sustained or nonsustained

Arrhythmia morphology – monomorphic VT, polymorphic VT, or VF

Associated symptoms – ranging from none to hemodynamic collapse and sudden cardiac arrest

Associated cardiac disease

                               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Mar 01 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Brooks R, Burgess JH. Idiopathic ventricular tachycardia. A review. Medicine (Baltimore) 1988; 67:271.
  2. Belhassen B, Viskin S. Idiopathic ventricular tachycardia and fibrillation. J Cardiovasc Electrophysiol 1993; 4:356.
  3. Tada H, Tadokoro K, Ito S, et al. Idiopathic ventricular arrhythmias originating from the tricuspid annulus: Prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation. Heart Rhythm 2007; 4:7.
  4. FROMENT R, GALLAVARDIN L, CAHEN P. Paroxysmal ventricular tachycardia; a clinical classification. Br Heart J 1953; 15:172.
  5. Rahilly GT, Prystowsky EN, Zipes DP, et al. Clinical and electrophysiologic findings in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardiogram. Am J Cardiol 1982; 50:459.
  6. Buxton AE, Waxman HL, Marchlinski FE, et al. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation 1983; 68:917.
  7. Deal BJ, Miller SM, Scagliotti D, et al. Ventricular tachycardia in a young population without overt heart disease. Circulation 1986; 73:1111.
  8. Lemery R, Brugada P, Bella PD, et al. Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. Circulation 1989; 79:990.
  9. Mont L, Seixas T, Brugada P, et al. The electrocardiographic, clinical, and electrophysiologic spectrum of idiopathic monomorphic ventricular tachycardia. Am Heart J 1992; 124:746.
  10. Ohe T, Shimomura K, Aihara N, et al. Idiopathic sustained left ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation 1988; 77:560.
  11. Kinoshita O, Kamakura S, Ohe T, et al. Frequency analysis of signal-averaged electrocardiogram in patients with right ventricular tachycardia. J Am Coll Cardiol 1992; 20:1230.
  12. Yarlagadda RK, Iwai S, Stein KM, et al. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation 2005; 112:1092.
  13. Markowitz SM, Litvak BL, Ramirez de Arellano EA, et al. Adenosine-sensitive ventricular tachycardia: right ventricular abnormalities delineated by magnetic resonance imaging. Circulation 1997; 96:1192.
  14. Globits S, Kreiner G, Frank H, et al. Significance of morphological abnormalities detected by MRI in patients undergoing successful ablation of right ventricular outflow tract tachycardia. Circulation 1997; 96:2633.
  15. Carlson MD, White RD, Trohman RG, et al. Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 1994; 24:720.
  16. Eguchi M, Tsuchihashi K, Nakata T, et al. Right ventricular abnormalities assessed by myocardial single-photon emission computed tomography using technetium-99m sestamibi/tetrofosmin in right ventricle-originated ventricular tachyarrhythmias. J Am Coll Cardiol 2000; 36:1767.
  17. Mehta D, McKenna WJ, Ward DE, et al. Significance of signal-averaged electrocardiography in relation to endomyocardial biopsy and ventricular stimulation studies in patients with ventricular tachycardia without clinically apparent heart disease. J Am Coll Cardiol 1989; 14:372.
  18. Oakes DF, Manolis AS, Estes NA 3rd. Limited clinical utility of endomyocardial biopsy in patients presenting with ventricular tachycardia without apparent structural heart disease. Clin Cardiol 1992; 15:24.
  19. Sugrue DD, Holmes DR Jr, Gersh BJ, et al. Cardiac histologic findings in patients with life-threatening ventricular arrhythmias of unknown origin. J Am Coll Cardiol 1984; 4:952.
  20. Fontaine G, Fontaliran F, Lascault G, et al. Arrhythmogenic right ventricular dysplasia. In: Cardiac Electrophysiology: From Cell to Bedside, Zipes DP, Jalife J (Eds), W.B. Saunders, Philadelphia 1995. p.754.
  21. Jaoude SA, Leclercq JF, Coumel P. Progressive ECG changes in arrhythmogenic right ventricular disease. Evidence for an evolving disease. Eur Heart J 1996; 17:1717.
  22. Hoffmayer KS, Machado ON, Marcus GM, et al. Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia. J Am Coll Cardiol 2011; 58:831.
  23. Niroomand F, Carbucicchio C, Tondo C, et al. Electrophysiological characteristics and outcome in patients with idiopathic right ventricular arrhythmia compared with arrhythmogenic right ventricular dysplasia. Heart 2002; 87:41.
  24. Boulos M, Lashevsky I, Gepstein L. Usefulness of electroanatomical mapping to differentiate between right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia. Am J Cardiol 2005; 95:935.
  25. Corrado D, Basso C, Leoni L, et al. Three-dimensional electroanatomical voltage mapping and histologic evaluation of myocardial substrate in right ventricular outflow tract tachycardia. J Am Coll Cardiol 2008; 51:731.
  26. Callans DJ, Menz V, Schwartzman D, et al. Repetitive monomorphic tachycardia from the left ventricular outflow tract: electrocardiographic patterns consistent with a left ventricular site of origin. J Am Coll Cardiol 1997; 29:1023.
  27. Coumel P, LeClerq JP, Slama R. monomorphic idiopathic ventricular tachycardia. In: Cardiac Electrophysiology and Arrhythmias, Zipes DP, Jalife J (Eds), Grune and Stratton, Orlando 1985. p.455.
  28. Coggins DL, Lee RJ, Sweeney J, et al. Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994; 23:1333.
  29. Lerman BB, Stein K, Engelstein ED, et al. Mechanism of repetitive monomorphic ventricular tachycardia. Circulation 1995; 92:421.
  30. Kim RJ, Iwai S, Markowitz SM, et al. Clinical and electrophysiological spectrum of idiopathic ventricular outflow tract arrhythmias. J Am Coll Cardiol 2007; 49:2035.
  31. Hayashi H, Fujiki A, Tani M, et al. Circadian variation of idiopathic ventricular tachycardia originating from right ventricular outflow tract. Am J Cardiol 1999; 84:99.
  32. Mitrani RD, Klein LS, Miles WM, et al. Regional cardiac sympathetic denervation in patients with ventricular tachycardia in the absence of coronary artery disease. J Am Coll Cardiol 1993; 22:1344.
  33. Schäfers M, Lerch H, Wichter T, et al. Cardiac sympathetic innervation in patients with idiopathic right ventricular outflow tract tachycardia. J Am Coll Cardiol 1998; 32:181.
  34. Marchlinski FE, Deely MP, Zado ES. Sex-specific triggers for right ventricular outflow tract tachycardia. Am Heart J 2000; 139:1009.
  35. Klein LS, Shih HT, Hackett FK, et al. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation 1992; 85:1666.
  36. Calkins H, Kalbfleisch SJ, el-Atassi R, et al. Relation between efficacy of radiofrequency catheter ablation and site of origin of idiopathic ventricular tachycardia. Am J Cardiol 1993; 71:827.
  37. Movsowitz C, Schwartzman D, Callans DJ, et al. Idiopathic right ventricular outflow tract tachycardia: narrowing the anatomic location for successful ablation. Am Heart J 1996; 131:930.
  38. Klein LS, Miles WM. Ablative therapy for ventricular arrhythmias. Prog Cardiovasc Dis 1995; 37:225.
  39. Jadonath RL, Schwartzman DS, Preminger MW, et al. Utility of the 12-lead electrocardiogram in localizing the origin of right ventricular outflow tract tachycardia. Am Heart J 1995; 130:1107.
  40. Wilber DJ, Baerman J, Olshansky B, et al. Adenosine-sensitive ventricular tachycardia. Clinical characteristics and response to catheter ablation. Circulation 1993; 87:126.
  41. Timmermans C, Rodriguez LM, Crijns HJ, et al. Idiopathic left bundle-branch block-shaped ventricular tachycardia may originate above the pulmonary valve. Circulation 2003; 108:1960.
  42. Sekiguchi Y, Aonuma K, Takahashi A, et al. Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery. J Am Coll Cardiol 2005; 45:887.
  43. Kanagaratnam L, Tomassoni G, Schweikert R, et al. Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia. J Am Coll Cardiol 2001; 37:1408.
  44. Ouyang F, Fotuhi P, Ho SY, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002; 39:500.
  45. Frey B, Kreiner G, Fritsch S, et al. Successful treatment of idiopathic left ventricular outflow tract tachycardia by catheter ablation or minimally invasive surgical cryoablation. Pacing Clin Electrophysiol 2000; 23:870.
  46. Stellbrink C, Diem B, Schauerte P, et al. Transcoronary venous radiofrequency catheter ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 1997; 8:916.
  47. Tada H, Ito S, Naito S, et al. Idiopathic ventricular arrhythmia arising from the mitral annulus: a distinct subgroup of idiopathic ventricular arrhythmias. J Am Coll Cardiol 2005; 45:877.
  48. Yamada T, Murakami Y, Yoshida N, et al. Preferential conduction across the ventricular outflow septum in ventricular arrhythmias originating from the aortic sinus cusp. J Am Coll Cardiol 2007; 50:884.
  49. Yokokawa M, Good E, Desjardins B, et al. Predictors of successful catheter ablation of ventricular arrhythmias arising from the papillary muscles. Heart Rhythm 2010; 7:1654.
  50. Gill JS, Prasad K, Blaszyk K, et al. Initiating sequences in exercise induced idiopathic ventricular tachycardia of left bundle branch-like morphology. Pacing Clin Electrophysiol 1998; 21:1873.
  51. Dixit S, Gerstenfeld EP, Callans DJ, Marchlinski FE. Electrocardiographic patterns of superior right ventricular outflow tract tachycardias: distinguishing septal and free-wall sites of origin. J Cardiovasc Electrophysiol 2003; 14:1.
  52. Callans DJ, Schwartzman D, Gottlieb CD, Marchlinski FE. Insights into the electrophysiology of ventricular tachycardia gained by the catheter ablation experience: "learning while burning". J Cardiovasc Electrophysiol 1994; 5:877.
  53. Marcus FI, Fontaine GH, Guiraudon G, et al. Right ventricular dysplasia: a report of 24 adult cases. Circulation 1982; 65:384.
  54. Blomström-Lundqvist C, Sabel KG, Olsson SB. A long term follow up of 15 patients with arrhythmogenic right ventricular dysplasia. Br Heart J 1987; 58:477.
  55. Ritchie AH, Kerr CR, Qi A, Yeung-Lai-Wah JA. Nonsustained ventricular tachycardia arising from the right ventricular outflow tract. Am J Cardiol 1989; 64:594.
  56. Lerman BB, Belardinelli L, West GA, et al. Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity. Circulation 1986; 74:270.
  57. Sung RJ, Shapiro WA, Shen EN, et al. Effects of verapamil on ventricular tachycardias possibly caused by reentry, automaticity, and triggered activity. J Clin Invest 1983; 72:350.
  58. Sung RJ, Keung EC, Nguyen NX, Huycke EC. Effects of beta-adrenergic blockade on verapamil-responsive and verapamil-irresponsive sustained ventricular tachycardias. J Clin Invest 1988; 81:688.
  59. Farzaneh-Far A, Lerman BB. Idiopathic ventricular outflow tract tachycardia. Heart 2005; 91:136.
  60. Lerman BB, Dong B, Stein KM, et al. Right ventricular outflow tract tachycardia due to a somatic cell mutation in G protein subunitalphai2. J Clin Invest 1998; 101:2862.
  61. Viskin S, Rosso R, Rogowski O, Belhassen B. The "short-coupled" variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia? J Cardiovasc Electrophysiol 2005; 16:912.
  62. Noda T, Shimizu W, Taguchi A, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol 2005; 46:1288.
  63. Viskin S, Antzelevitch C. The cardiologists' worst nightmare sudden death from "benign" ventricular arrhythmias. J Am Coll Cardiol 2005; 46:1295.
  64. Gill JS, Blaszyk K, Ward DE, Camm AJ. Verapamil for the suppression of idiopathic ventricular tachycardia of left bundle branch block-like morphology. Am Heart J 1993; 126:1126.
  65. Rodriguez LM, Smeets JL, Timmermans C, Wellens HJ. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol 1997; 79:309.
  66. Gerstenfeld EP, Dixit S, Callans DJ, et al. Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia. J Am Coll Cardiol 2003; 41:2046.
  67. Schweikert RA, Saliba WI, Tomassoni G, et al. Percutaneous pericardial instrumentation for endo-epicardial mapping of previously failed ablations. Circulation 2003; 108:1329.
  68. Chinushi M, Aizawa Y, Takahashi K, et al. Radiofrequency catheter ablation for idiopathic right ventricular tachycardia with special reference to morphological variation and long-term outcome. Heart 1997; 78:255.
  69. Flemming MA, Oral H, Kim MH, et al. Electrocardiographic predictors of successful ablation of tachycardia or bigeminy arising in the right ventricular outflow tract. Am J Cardiol 1999; 84:1266.
  70. Lerman BB, Stein KM, Markowitz SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pacing Clin Electrophysiol 1996; 19:2120.
  71. Zipes DP, Foster PR, Troup PJ, Pedersen DH. Atrial induction of ventricular tachycardia: reentry versus triggered automaticity. Am J Cardiol 1979; 44:1.
  72. Belhassen B, Rotmensch HH, Laniado S. Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1981; 46:679.
  73. Nakagawa H, Beckman KJ, McClelland JH, et al. Radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential. Circulation 1993; 88:2607.
  74. Wen MS, Yeh SJ, Wang CC, et al. Radiofrequency ablation therapy in idiopathic left ventricular tachycardia with no obvious structural heart disease. Circulation 1994; 89:1690.
  75. German LD, Packer DL, Bardy GH, Gallagher JJ. Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. Am J Cardiol 1983; 52:1202.
  76. Klein GJ, Millman PJ, Yee R. Recurrent ventricular tachycardia responsive to verapamil. Pacing Clin Electrophysiol 1984; 7:938.
  77. Ward DE, Nathan AW, Camm AJ. Fascicular tachycardia sensitive to calcium antagonists. Eur Heart J 1984; 5:896.
  78. Ouyang F, Cappato R, Ernst S, et al. Electroanatomic substrate of idiopathic left ventricular tachycardia: unidirectional block and macroreentry within the purkinje network. Circulation 2002; 105:462.
  79. Okumura K, Matsuyama K, Miyagi H, et al. Entrainment of idiopathic ventricular tachycardia of left ventricular origin with evidence for reentry with an area of slow conduction and effect of verapamil. Am J Cardiol 1988; 62:727.
  80. Kinoshita O, Kamakura S, Ohe T, et al. Spectral analysis of signal-averaged electrocardiograms in patients with idiopathic ventricular tachycardia of left ventricular origin. Circulation 1992; 85:2054.
  81. Nogami A, Naito S, Tada H, et al. Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Am Coll Cardiol 2000; 36:811.
  82. Nogami A, Naito S, Tada H, et al. Verapamil-sensitive left anterior fascicular ventricular tachycardia: results of radiofrequency ablation in six patients. J Cardiovasc Electrophysiol 1998; 9:1269.
  83. Francis J, Venugopal K, Khadar SA, et al. Idiopathic fascicular ventricular tachycardia. Indian Pacing Electrophysiol J 2004; 4:98.
  84. Gupta AK, Kumar AV, Lokhandwala YY, et al. Primary radiofrequency ablation for incessant idiopathic ventricular tachycardia. Pacing Clin Electrophysiol 2002; 25:1555.
  85. European Heart Rhythm Association, Heart Rhythm Society, Zipes DP, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247.
  86. Aliot EM, Stevenson WG, Almendral-Garrote JM, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 2009; 11:771.