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Nonsustained VT in the absence of apparent structural heart disease

Robert Phang, MD, FACC, FHRS
Section Editor
Samuel Lévy, MD
Deputy Editor
Brian C Downey, MD, FACC


Nonsustained ventricular tachycardia (NSVT), defined as three or more consecutive ventricular beats at a rate of greater than 100 beats/min with a duration of less than 30 seconds (waveform 1), is a relatively common clinical problem [1]. It is often asymptomatic and typically diagnosed during cardiac monitoring (eg, ambulatory monitoring or inpatient telemetry) or an exercise test performed for other reasons. If the patient is asymptomatic, the major clinical challenge is to determine if the NSVT is relatively benign or indicative of an increased risk of sudden cardiac death. A major determinant of prognosis in patients with NSVT is the presence or absence of underlying structural heart disease as diagnosed using other modalities (eg, echocardiography, exercise stress testing, cardiac computed tomography or magnetic resonance imaging). The 12 lead electrocardiogram should also be assessed in conjunction with imaging and is particularly important in screening for inherited channelopathies, as those conditions often have no apparent structural heart disease.

This topic will discuss NSVT in patients without apparent structural heart disease. NSVT occurring in patients with different forms of heart disease, as well as sustained VT in patients without apparent structural heart disease, are discussed separately. (See "Monomorphic ventricular tachycardia in the absence of apparent structural heart disease" and "Catecholaminergic polymorphic ventricular tachycardia and other polymorphic ventricular tachycardias with a normal QT interval".)


NSVT, with an incidence ranging from 0 to 4 percent in the general population, is more common with increasing age and more often occurs in men [2]. These incidence figures are drawn from studies using prolonged recordings in relatively small numbers of normal subjects. It is likely, however, that a single 24-hour recording significantly underestimates the true frequency of this often asymptomatic and intermittent arrhythmia.


The initial challenge may be determining if the wide complex tachycardia (WCT) is truly of ventricular origin versus aberrantly conducted supraventricular beats. Aberrancy involves the premature activation of the bundle branches where one bundle conducts normally and the other is still refractory and therefore exhibits a typical bundle branch pattern, usually the right bundle branch block (RBBB). Various morphologic clues favor aberrancy, including:

Visualization of a premature atrial contraction immediately preceding the WCT

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Literature review current through: Nov 2017. | This topic last updated: Aug 25, 2017.
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  1. American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology), Buxton AE, Calkins H, et al. ACC/AHA/HRS 2006 key data elements and definitions for electrophysiological studies and procedures: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology). Circulation 2006; 114:2534.
  2. Marine JE, Shetty V, Chow GV, et al. Prevalence and prognostic significance of exercise-induced nonsustained ventricular tachycardia in asymptomatic volunteers: BLSA (Baltimore Longitudinal Study of Aging). J Am Coll Cardiol 2013; 62:595.
  3. Lerman B, Stein, K, et al. Ventricular tachycardia in patients with structurally normal hearts. In: Cardiac Electrophysiology: From Cell to Beside, 4th ed, 2004. p.668.
  4. Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111:659.
  5. Kinder C, Tamburro P, Kopp D, et al. The clinical significance of nonsustained ventricular tachycardia: current perspectives. Pacing Clin Electrophysiol 1994; 17:637.
  6. Kennedy HL, Whitlock JA, Sprague MK, et al. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 1985; 312:193.
  7. Cullen K, Stenhouse NS, Wearne KL, Cumpston GN. Electrocardiograms and 13 year cardiovascular mortality in Busselton study. Br Heart J 1982; 47:209.
  8. Bikkina M, Larson MG, Levy D. Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study. Ann Intern Med 1992; 117:990.
  9. Abdalla IS, Prineas RJ, Neaton JD, et al. Relation between ventricular premature complexes and sudden cardiac death in apparently healthy men. Am J Cardiol 1987; 60:1036.
  10. Montague TJ, McPherson DD, MacKenzie BR, et al. Frequent ventricular ectopic activity without underlying cardiac disease: analysis of 45 subjects. Am J Cardiol 1983; 52:980.
  11. Fleg JL, Kennedy HL. Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects greater than or equal to 60 years of age. Am J Cardiol 1992; 70:748.
  12. McHenry PL, Fisch C, Jordan JW, Corya BR. Cardiac arrhythmias observed during maximal treadmill exercise testing in clinically normal men. Am J Cardiol 1972; 29:331.
  13. Fleg JL, Lakatta EG. Prevalence and prognosis of exercise-induced nonsustained ventricular tachycardia in apparently healthy volunteers. Am J Cardiol 1984; 54:762.
  14. Froelicher VF Jr, Thomas MM, Pillow C, Lancaster MC. Epidemiologic study of asymptomatic men screened by maximal treadmill testing for latent coronary artery disease. Am J Cardiol 1974; 34:770.
  15. Yang JC, Wesley RC Jr, Froelicher VF. Ventricular tachycardia during routine treadmill testing. Risk and prognosis. Arch Intern Med 1991; 151:349.
  16. Lin D, Callans DJ. Nonsustained VT during exercise testing: causes and work-up. Am Coll Cardiol Curr J Rev 2003; Nov-Dec:57.