Sustained ventricular tachycardia in structural heart disease

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Ventricular arrhythmias, particularly ventricular tachycardia (VT), are a leading cause of sudden cardiac death (SCD), especially in patients with underlying structural heart disease.
• Coronary artery disease, often following myocardial infarction, is the most frequent condition associated with sustained VT, primarily driven by reentry mechanisms.

Purpose of the Study:

• To review the diagnostic approaches and therapeutic strategies for ventricular arrhythmias.
• To highlight the role of electrocardiogram (ECG) and electrophysiological studies in diagnosing VT and guiding treatment.
• To emphasize the efficacy of catheter ablation and implantable cardioverter-defibrillator (ICD) therapy in managing VT and improving survival.

Main Methods:

• Analysis of the 12-lead electrocardiogram (ECG) for diagnosing VT and identifying underlying heart disease.
• Electrophysiological study (EPS) to elucidate arrhythmia mechanisms and guide ablation procedures.
• Review of current therapeutic options including antiarrhythmic drugs, catheter ablation, and ICD therapy.

Main Results:

• ECG criteria offer good specificity for VT diagnosis and localization.
• Electrophysiological studies provide crucial information for diagnosis and ablation guidance.
• Catheter ablation reduces VT recurrence and defibrillator shocks; ICD therapy is the only proven survival-improving treatment for high-risk patients.

Conclusions:

• ECG interpretation and electrophysiological studies are essential for managing ventricular arrhythmias.
• While antiarrhythmic drugs have limited efficacy, catheter ablation and ICD therapy significantly improve patient outcomes and survival in structural heart disease.
• ICD implantation is a critical, unquestioned intervention for patients with aborted SCD or sustained VT.