Life threatening ventricular arrhythmias with transient or correctable causes

Traditionally, myocardial ischemia, electrolyte disorders, and proarrhythmic drug reactions have been considered transient and correctable causes of life threatening ventricular tachyarrhythmias. Recent evidence suggests that patients whose ventricular tachyarrhythmias are attributed to these "causes" have a poor outcome. This overview reviews the available literature examining ischemia, electrolyte disorders and pro-arrhythmic drug reactions as potentially reversible causes of ventricular tachycardia (VT) and ventricular fibrillation (VF). While all 3 are undoubtedly involved in the genesis of these tachyarrhythmias, and all 3 deserve particular clinical attention (outlined in the text), difficulties in the identification and/or reversal of their influences exist. Proarrhythmic drug reaction may be a reversible cause of VT/VF, hypokalemia and hypomagnesemia should be considered risk factors for VT/VF, and the role of ischemia is complex. Accordingly, physicians should use extreme caution in attributing life-threatening ventricular tachyarrhythmias to these 3 conditions. Further research is required to identify "truly reversible" causes of VT/VF.