Symptomatic Ventricular Tachycardia

The approach to patients with symptomatic ventricular tachycardia (VT) depends on the presence and type of structural heart disease. In patients with underlying heart disease and ventricular fibrillation or sustained symptomatic VT with hemodynamic compromise, the implantable cardioverter-defibrillator (ICD) is superior to antiarrhythmic drugs for the improvement of overall survival. These patients should receive an ICD unless contraindications are present. For patients with sustained VT and a structurally normal heart (idiopathic VT), radiofrequency catheter ablation is a reasonable option. If patients are symptomatic, nonsustained VT should be treated with beta-adrenergic blocking agents or antiarrhythmic drugs, which should be selected on the basis of the underlying cardiovascular substrate. In patients with coronary artery disease, depressed left ventricular function, and nonsustained VT, we recommend the use of programmed electrical stimulation for additional risk stratification. If a sustained ventricular arrhythmia is induced, an ICD should be implanted.