What is included in poststabilization management of ventricular tachycardia (VT)?

Updated: Dec 05, 2017
  • Author: Steven J Compton, MD, FACC, FACP, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

After initial treatment and stabilization, patients with ventricular tachycardia (VT) generally should undergo the following:

  • Referral to a cardiologist
  • Admission to a monitored bed
  • Further studies, such as electrophysiologic study (EPS)
  • Consideration for radiofrequency ablation (RFA)
  • Consideration for ICD placement

Initiation of antiarrhythmic medications may require telemetry monitoring for drug-induced proarrhythmia. Patients starting class IA and class III drugs should be monitored for corrected QT (QTc) prolongation and torsade de pointes until steady-state drug levels (≥5 clearance half-lives) have been reached. A notable exception is amiodarone, which may require months to achieve steady state; drug loading of amiodarone is necessarily completed on an outpatient basis. [55]

Class IC antiarrhythmics are associated with drug-induced VT and rate-related conduction slowing. Many centers commit their patients to telemetry monitoring and predischarge exercise testing during initiation of agents from this class. Sinus bradycardia and sinus node dysfunction are often exacerbated by antiarrhythmic drugs.

Adult patients with ventricular arrhythmias whose age, sex, and symptoms indicate a moderate or greater likelihood of coronary heart disease, should undergo exercise testing to provoke ischemic changes or ventricular arrhythmias. [40] Regardless of age, exercise testing is useful in patients with established or suspected exercise-induced ventricular arrhythmias, including catecholaminergic VT, to provoke the arrhythmia, to confirm a diagnosis, and to ascertain the patient’s response to tachycardia. [40]


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