Sustained and nonsustained ventricular tachycardia: genesis, significance, and management

Patients with sustained and nonsustained ventricular tachycardia may present the clinician with difficult management problems in the assessment of risk, decision for long-term treatment, and selection of appropriate therapy. Many therapeutic modalities are available, and combinations may be required in a comprehensive treatment program. The development of safer and more effective means for VT control is progressing and is needed. Nonetheless, the results of therapy with many of the treatment programs described are encouraging, as exemplified by the report from Graboys and coworkers. Long-term survival was studied in a group of 123 patients with malignant ventricular arrhythmia treated with antiarrhythmic drugs chosen primarily with noninvasive testing methods. In 98 patients in whom complex ventricular ectopy was controlled, there were 6 sudden deaths, that is, an annual mortality of 2.3 percent. In 25 patients in whom ectopy persisted despite drug therapy, there were 17 sudden deaths. Continued study of the specific mechanisms leading to ventricular tachycardia and sudden death are needed in order to control this increasingly prevalent clinical problem.