Nonsustained ventricular tachycardias

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 12 Aug 2025

Last updated: 24 Nov 2023

Nonsustained ventricular tachycardia (NSVT) is usually asymptomatic, although brief palpitations may sometimes be experienced. Symptoms in a patient with known NSVT are most often attributed to underlying cardiac disease rather than the arrhythmia itself.

Defined as a self-terminating event. No specific treatment indicated. Management is directed at any underlying heart condition.

Implantable cardioverter defibrillator placement may be used for selected patients who have additional risk factors such as structural heart disease. Patients at risk for sudden cardiac death and who also have discordant contraction of left ventricular function may benefit from cardiac resynchronization therapy.

Prognosis dependent on presence or absence of cardiac disease. Left ventricular function in post-myocardial infarction patients remains the most important prognostic tool for overall mortality and risk for sudden cardiac death.

No increase in mortality demonstrated in those patients without associated cardiac disease.

Definition

Nonsustained ventricular tachycardia (NSVT) is an ectopic ventricular rhythm with wide QRS complex (≥120 milliseconds), rate faster than 100 bpm, lasting for at least 3 beats that spontaneously resolves in less than 30 seconds.[1][2] It may occur in the absence of any underlying heart disease. However, it is more commonly associated with ischemic and nonischemic heart disease; known genetic disorders (e.g., long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy); congenital heart disease; metabolic problems including drug toxicity; or electrolyte imbalance.[3]

History and exam

Key diagnostic factors

history of coronary artery disease
history of hypertrophic cardiomyopathy
history of idiopathic dilated cardiomyopathy
presence of other known causes
asymptomatic presentation
tachycardia

Full details

Other diagnostic factors

palpitations
dizziness
lightheadedness
presyncope
syncope

Full details

Risk factors

coronary artery disease
left ventricular systolic dysfunction
hypertrophic cardiomyopathy
idiopathic dilated cardiomyopathy
long QT syndrome
Brugada syndrome
electrolyte imbalance
drug toxicity
Chagas disease and other cardiomyopathies
sleep-disordered breathing
catecholaminergic polymorphic VT
family history of sudden death
mental or physical stress

Full details

Diagnostic tests

1st tests to order

ECG
electrolyte panel
troponin
CK-MB

Full details

Tests to consider

24-hour ambulatory ECG monitoring
echocardiogram
cardiac catheterization
cardiac MRI with gadolinium
electrophysiologic testing
stress testing
genetic screening

Full details

Treatment algorithm

ONGOING

no cardiac comorbidity: asymptomatic and ≤10% NSVT/premature ventricular contraction (PVC) burden

no cardiac comorbidity: symptomatic NSVT or >10% asymptomatic NSVT/premature ventricular contraction (PVC) burden

chronic coronary artery disease (CAD)

post-myocardial infarction (MI)

idiopathic dilated or hypertrophic cardiomyopathy

Contributors

Authors

Fred Kusumoto, MD

Professor of Medicine

Mayo Medical School

Division of Cardiovascular Diseases

Department of Medicine

Mayo Clinic Florida

Jacksonville

Disclosures

FK declares that he has no competing interests.

Acknowledgements

Professor Kusumoto would like to gratefully acknowledge Dr Ronald R. Butendieck Jr, a previous contributor to this topic.

Disclosures

RRB declares that he has no competing interests.

Peer reviewers

Timothy Markman, MD

Assistant Professor of Medicine

Hospital of the University of Pennsylvania

Philadelphia

Disclosures

TM declares that he has no competing interests.

Vias Markides, MB(Hons), BS(Hons), MD, FRCP

Consultant Cardiologist and Chair

Arrhythmias

Royal Brompton & Harefield NHS Trust

Hon. Senior Lecturer

Imperial College

London

Disclosures

VM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2018 Sep 25;138(13):e272-e391.Full text Abstract

Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126.Full text Abstract

Katritsis DG, Zareba W, Camm AJ. Nonsustained ventricular tachycardia. J Am Coll Cardiol. 2012 Nov 13;60(20):1993-2004.Full text Abstract

Goldberger JJ, Cain ME, Hohnloser SH, et al. American Heart Association/American College of Cardiology/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. Circulation. 2008 Sep 30;118(14):1497-1518. Abstract

Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Circulation. 2008 Jun;117(6):e350-408.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- SVT with aberrant conduction
- Electrical artifact
More Differentials
Guidelines
- 2022 ESC guideline for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
- 2022 AHA/ACC/HFSA guideline for the management of heart failure
More Guidelines
Patient information
Heart attack
Heart attack: what is it?
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Nonsustained ventricular tachycardias

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

no cardiac comorbidity: asymptomatic and ≤10% NSVT/premature ventricular contraction (PVC) burden

no cardiac comorbidity: symptomatic NSVT or >10% asymptomatic NSVT/premature ventricular contraction (PVC) burden

chronic coronary artery disease (CAD)

post-myocardial infarction (MI)

idiopathic dilated or hypertrophic cardiomyopathy

Contributors

Authors

Fred Kusumoto, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Timothy Markman, MD

Disclosures

Vias Markides, MB(Hons), BS(Hons), MD, FRCP

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

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