Nonsustained ventricular tachycardia
Ventricular tachycardia can either be nonsustained or sustained, with or without the presence of structural heart disease.
See Initial management of any acute tachyarrhythmia for initial management of any acute tachyarrhythmia and Management of stable acute wide-complex tachyarrhythmia for management of stable acute wide-complex tachyarrhythmia.
Nonsustained ventricular tachycardia is defined as ventricular tachycardia lasting 3 or more beats but less than 30 seconds. It is often asymptomatic and incidentally detected during routine examination. It can be the cause or the result of left ventricular dysfunction; perform an echocardiogram to evaluate patients for underlying structural heart disease. Referral to a cardiologist is usually recommended.
Only treat nonsustained ventricular tachycardia if there are prolonged episodes with haemodynamic compromise, or if significant symptoms (such as syncope) are present. Attempt to treat the underlying cause, such as ischaemia or electrolyte abnormalities (eg hypokalaemia), rather than the arrhythmia itself.
For treatment of nonsustained ventricular tachycardia associated with haemodynamic compromise or significant symptoms, suitable regimens are:
1atenolol 25 mg orally, daily, increasing if required up to 100 mg daily atenolol atenolol atenolol
OR
1metoprolol tartrate 25 mg orally, twice daily, increasing if required up to 100 mg twice daily. metoprolol metoprolol metoprolol
Verapamil or flecainide may be alternatives if beta blockers are contraindicated or not tolerated, provided the patient has no evidence of left ventricular dysfunction. Also avoid flecainide if the patient has significant coronary artery disease. Suitable regimens are:
1flecainide 50 mg orally, twice daily, increasing if required up to 150 mg twice daily flecainide flecainide flecainide
OR
1verapamil modified-release 180 mg orally daily, increasing if required up to 360 mg daily. verapamil verapamil verapamil
If symptoms persist or there is suspicion of a cardiomyopathy secondary to the nonsustained ventricular tachycardia, amiodarone may be considered. A suitable regimen is:
amiodarone 200 to 400 mg orally, 3 times daily for 1 week, then twice daily for 1 week, then once daily. amiodarone amiodarone amiodarone
Catheter ablation may be considered for a patient with significant symptoms not controlled by drug therapy, or if there is suspicion of cardiomyopathy—seek specialist cardiology advice.