Therapy of ventricular tachycardia in patients with nonischemic cardiomyopathies

In patients with IDCM and sustained VT, every effort should be made to exclude bundle branch reentrant tachycardia. We strongly believe that this mechanism of VT remains underdiagnosed despite electrophysiologic evaluation. In appropriate candidates with cardiomyopathies and "nonbundle branch reentrant VT," ICD implantation is frequently the treatment of choice, especially if the clinical presentation is that of hemodynamic collapse, or there is significant left ventricular systolic dysfunction. The role of amiodarone versus ICD, especially for patients with well-tolerated VT and milder forms of cardiomyopathies, is yet to be defined.