Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease.

Abstract

This report describes the clinical, laboratory, and electrophysiologic features of 52 patients with ventricular tachycardia (VT) who had no clinical evidence of heart disease. The mean age of patients was 36 years, cardiovascular collapse occurred in 18 patients (35%), and exerciserelated symptoms were present in 24 of 49 patients (49%). There were 20 patients with sustained monomorphic VT, 11 with incessant VT, and 21 with nonsustained VT. Abnormalities were present in 14 of 38 patients (37%) during echocardiography and in 21 of 47 patients (45%) who underwent cardiac catheterization. During baseline evaluation while patients were not receiving antiarrhythmic drugs, ambulatory monitoring and exercise testing showed an 88% and 57% incidence, respectively, of nonsustained or sustained monomorphic VT, whereas 31 of 50 patients (62%) had inducible VT (requiring an infusion of isoproterenol in 11 patients) during programmed electrical stimulation. The clinical VT (when a 12-lead electrocardiogram was available for analysis) had a left bundle branch block (LBBB) configuration in 20 of 33 patients (61%) and a right axis deviation in 17 of 33 patients (51%). The VT occurring during exercise testing and programmed electrical stimulation had the same configuration as the clinical VT in 22 of 22 patients. Three patients have received an antitachycardia pacemaker, and one patient underwent endocardial resection. Forty-eight patients (92%) were treated medically. One patient died of cancer; the remaining 47 patients were alive at a mean follow-up of 96 months after initial symptoms and 46 months after programmed electrical stimulation. We conclude that in patients without clinical evidence of heart disease, VT may be incessant, sustained, or nonsustained and that VT originates from the right ventricular outflow tract in more than 501% of patients. Although cardiac abnormalities may be found in more than 30% of patients, the exact significance of these abnormalities is unclear because of the absence of progressive changes and the excellent prognosis of this group of patients. (Circulation 1989:79:990-999) "What seems to be important is the general myocardial integrity in young subjects who are capable of tolerating the most frequent paroxysms."Froment et all V entricular tachycardia (VT) occurring in subjects without evidence of clinical heart disease was described more than 60 years ago. Gallavardin's2 initial observations, later followed by those of Parkinson and Papp,3 led Froment et all in 1953 to classify VT into four groups, of which two groups had apparently normal hearts: On one hand, "ventricular extrasystoles with parox-

Contemporary Management of Arrhythmias During Pregnancy

“…49 It may present for the first time during pregnancy. It is often catecholamine sensitive, and treatment of outflow tract VT with cardioselective β-blockers in pregnant patients is usually effective.…”

Cardiomyopathy With Frequent Ventricular Premature Depolarization – Predicting Irreversible Ventricular Dysfunction –

“…Pre-existing occult structural heart disease was recently suggested as a potential mechanism of frequent VPD with LV dysfunction. [16][17][18] In this study of patients with frequent VPD and LV dysfunction, LVEDD <66 mm predicted reversibility of LV function after successful VPD suppression with 100% sensitivity and 50% specificity. In 68% of patients with reversible CMP, LV function normalized within 6 months after VPD suppression; in 18% of patients, LV function normalized >1 year after successful suppression of clinical VPD.…”

“…17,18-21 Lemery et al described the clinical, laboratory, and electrophysiological features of patients with idiopathic VT who had no clinical evidence of heart disease. 17 They detected minor structural cardiac abnormalities in >30% of these patients. Similarly, Nishikawa et al described advanced histopathological findings including myocyte hypertrophy, degeneration, interstitial fibrosis, and disarrangement of muscle bundles, in patients with idiopathic VT. 19 No significant abnormalities were found …”

The ventricular ectopic QRS interval (VEQSI): Diagnosis of arrhythmogenic right ventricular cardiomyopathy in patients with incomplete disease expression

“…Whereas RVOT ectopy appears benign, ARVC is associated with risk of SCD. (5,6) During the concealed phase, ARVC diagnosis is difficult due to diffuse structural abnormalities. Imaging demonstrates normal cardiac appearance or subtle nondiagnostic anomalies.…”

“…Whereas RVOT ectopy appears benign, ARVC is associated with risk of SCD. (5,6) In early ARVC, cardiac imaging is frequently normal and electrical changes appear to predate structural changes. (4,7,8 VEQSI measurement only requires presence of VEB making it applicable for a greater number of patients.…”