Ventricular tachycardia is a major cardiac electrical disorder. Even though it connotes a deadly meaning the prognosis and outcome vastly vary.It can be a benign arrhythmia in structurally normal heart that present as occasional fasicular VT or Exercise induced RVOT , to dangerous ischemic polymorphic VT which rapidly degenerate to VF and SCD if not reverted . It is ironical we are trained to put all VTs in a single basket and propagate fear psychosis among physicians and patients .
Management of VT has certain broad principles.
- Identify the cause
- Whether specific structural heart diseases present or not
- Identify the mechanism if possible
- Rule out transient metabolic cause as a trigger
- Stabilising the cell of origin
- Passifying the scars
- Interrupting bundle branches in BBR mediated tachycardia
- Ischemia related Focus – Re-perfusion
- Reversing LV dysfunction
- Correct Cell hypoxia /Acidois
- Pharmacological ( Class 1A/1B /1C , class 3 and Beta blockers , Magnesium )
- Role of beta blockers for VT management is largely under recognised.It has an important role to play in both acute and chronic VTs)
Electrical (DC shock ,Ablation and ICD)
- DC shock is treatment of choice all emergency VTs
- Ablation aims at preventing episodes of VT .Ablation needs EP study and expertise of an electro physiologist.
- ICDs revert it only after the VT emanates from the focus . ICD can be implanted without knowing the focus .May not require a EP consult.
CABG + Surgical scar excision , Aneurysectomy might help in certain refractory VT.