Nonsustained ventricular tachycardia: Clinical manifestations, evaluation, and management
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Harvard Medical School
- John V Wylie, MD, FACC
John V Wylie, MD, FACC
- Assistant Professor of Medicine
- Tufts Medical School
Nonsustained ventricular tachycardia (NSVT) is a common but poorly understood arrhythmia. It is usually asymptomatic and most often diagnosed during cardiac monitoring (eg, continuous ambulatory electrocardiography or inpatient telemetry) or on an exercise test performed for other reasons.
The presence of NSVT has long been recognized as a potential marker for the development of sustained ventricular arrhythmias and sudden death. However, while NSVT predicts overall mortality, it doesn’t specifically predict sudden cardiac death (SCD). Unfortunately, our understanding of which patients with NSVT are at greatest risk for lethal arrhythmias or how the NSVT relates to the lethal arrhythmias is still quite rudimentary. One clearly established premise is that NSVT in the presence of structural heart disease carries a more serious prognosis than NSVT in the absence of a cardiac abnormality. Since NSVT doesn’t specifically predict SCD, the nature of the underlying structural heart disease is the primary determinant of mortality. (See "Nonsustained VT in the absence of apparent structural heart disease".)
There are two general goals in the management of NSVT:
●Identification of patients at risk for malignant, sustained arrhythmias and SCD
●Treatment to suppress symptoms caused by NSVT, when present and clinically significant
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- DEFINITION OF NSVT
- CLINICAL MANIFESTATIONS
- History and associated symptoms
- Physical examination
- Diagnostic evaluation
- DIFFERENTIAL DIAGNOSIS
- Symptomatic patients
- - Beta blockers
- - Nondihydropyridine calcium channel blockers
- - Antiarrhythmic drugs
- Class I agents
- - Radiofrequency catheter ablation
- - Implantable cardioverter-defibrillators
- Asymptomatic patients
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS