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[Permanent ventricular tachycardia: prognostic and therapeutic problems: three case reports]
Youssef Ben Ameur1, Karima Ouchallal, Mohamed Hmam
1Service de cardiologie Hôpital Habib Thameur, Tunis.
La Tunisie Medicale
|March 4, 2003
Summary
Permanent ventricular tachycardia (PVT) is a dangerous arrhythmia in advanced cardiomyopathy. Radiofrequency ablation (RFA) is the preferred treatment for PVT resistant to medical therapy.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Permanent ventricular tachycardia (PVT) presents significant prognostic and therapeutic challenges.
- PVT often complicates advanced cardiomyopathies, including ischemic and idiopathic types.
Observation:
- Three patients with sustained monomorphic ventricular tachycardia were admitted.
- ECG revealed wide QRS tachycardia of ventricular origin; echocardiography showed dilated left ventricles with reduced ejection fraction.
- Cardiac catheterization identified coronary artery disease in two patients, but revascularization was not indicated due to infarct age.
Findings:
- Ventricular tachycardia persisted for over six days, recurring after direct current shock and resisting lidocaine-amiodarone.
- Pharmacological treatment with propranolol-amiodarone or amiodarone for heart failure achieved sinus rhythm in two patients.
- One patient died from PVT-induced cardiogenic shock before radiofrequency ablation could be attempted.
Implications:
- PVT in advanced cardiomyopathy is difficult to manage, often worsening hemodynamic status.
- Pharmacological treatment for PVT is frequently challenging and may be ineffective.
- Radiofrequency ablation (RFA) emerges as the treatment of choice for PVT refractory to medical management.