Long-term management of sustained ventricular tachycardia with structural heart disease

Patients with sustained ventricular tachycardia should be thoroughly evaluated for the presence of structural heart disease, in particular the presence of coronary artery disease and left ventricular dysfunction.

Consider early referral of patients with sustained ventricular tachycardia and structural heart disease to a cardiac electrophysiologist; an implantable cardioverter defibrillator (ICD) may be appropriate. Several large trials have demonstrated a reduction in mortality with an ICD compared to antiarrhythmic drugs in patients with sustained ventricular tachycardia and structural heart disease. Antiarrhythmic drugs do not improve survival in these patientsPedersen, 2014.

Although ICDs prevent sudden death, they do not prevent recurrence of ventricular tachycardia, so an antiarrhythmic drug can be added to manage symptoms. To determine whether to add an antiarrhythmic drug, consider:

• the frequency of, and symptoms associated with, ventricular tachycardia
• the type of implantable defibrillator therapy
• patient preference
• potential adverse effects of the drug.

Amiodarone or sotalol can be used under specialist supervision for recurrent ventricular tachycardia in patients with significant left ventricular dysfunction.

Catheter ablation can also be considered in patients with recurrent ventricular tachycardia.