Work-up and management of patients with sustained and nonsustained monomorphic ventricular tachycardias

The approach to patients with hemodynamically-stable sustained monomorphic ventricular tachycardia (VT) must be individualized. The clinical outcome is critically dependent on the type and degree of underlying heart disease, symptoms at presentation, inducibility at electrophysiology study, and responses to antiarrhythmic drugs. Various methods for assessing therapeutic efficacy and both pharmacologic and nonpharmacologic therapies are discussed. The majority of patients with nonsustained VT have no symptoms directly attributable to this arrhythmia that is associated with an increased risk for sudden death in certain patients with coronary artery disease and hypertrophic cardiomyopathy. The optimal means to prophylax against sudden death in these patients is not presently clear, but prospective trials are underway to evaluate this problem.