Ventricular arrhythmia: management guidelines for the primary health care setting

Ventricular arrhythmia is a common problem in the ambulatory setting. Ventricular arrhythmias that appear to be similar on the electrocardiograph may have different prognostic significance, depending on the patient's age and the presence of underlying heart disease or ventricular dysfunction. The ultimate goal in the care of any patient with ventricular arrhythmia is prevention of sudden cardiac death. Patients can usually be classified into one of five diagnostic categories, based on symptoms and evidence of underlying heart disease. This article discusses the classification of ventricular arrhythmias as either benign, potentially malignant or malignant. The risks of antiarrhythmic therapy and specific management plans for each of the five diagnostic categories are provided. These management plans are meant to serve as a framework for the clinician who provides primary care to these patients. An explanation of terms used commonly in the interpretation of ventricular arrhythmias is included, as well as guidelines for the assessment of patients with ventricular arrhythmias.