Nonsustained ventricular tachycardia: identification and management of high-risk patients

NSVT is common in normal persons and in patients with a variety of heart diseases. When present in patients with coronary artery disease, particularly after a recent myocardial infarction, it is associated with an increased risk of sudden and nonsudden cardiac death. However, its prognostic significance in patients with nonischemic heart disease, with the possible exception of hypertrophic cardiomyopathy, remains controversial. In patients with coronary artery disease, certain diagnostic tools (e.g., determination of left ventricular function. PVS) help to identify low- and high-risk patients who may or may not benefit from antiarrhythmic treatment. There is no consensus at this point as to the best approach for identifying and treating high-risk patients. Ongoing clinical trials should provide important information on the roles of signal-averaged ECGs and PVS in the management of patients with NSVT and coronary artery disease. In the meantime, treatment should be individualized for each patient. beta-Blockers should probably be the first line of therapy to control symptoms. Asymptomatic potentially high-risk patients (i.e., those with LVEF < 40%) should be referred for enrollment in randomized controlled studies.