Nonsustained ventricular tachycardia 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 (ICD) 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 (CRT).
Prognosis dependent on presence or absence of cardiac disease. Left ventricular function in post-MI 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.
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. 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 such as long QT syndrome, Brugada syndrome, and arrhythmogenic right ventricular cardiomyopathy; congenital heart disease; metabolic problems including drug toxicity; or electrolyte imbalance.
History and exam
Key diagnostic factors
- history of CAD
- history of hypertrophic cardiomyopathy
- history of idiopathic dilated cardiomyopathy
- presence of other known causes
- asymptomatic presentation
Other diagnostic factors
- left ventricular systolic dysfunction
- hypertrophic cardiomyopathy
- idiopathic dilated cardiomyopathy
- long QT syndrome
- Brugada syndrome
- electrolyte imbalance
- drug toxicity
- Chagas disease and other cardiomyopathies
- catecholaminergic polymorphic VT
- family history of sudden death
- mental or physical stress
1st investigations to order
- electrolyte panel
Investigations to consider
- 24-hour ambulatory ECG monitoring
- cardiac catheterization
- cardiac MRI with gadolinium
- electrophysiologic testing
- stress testing
- genetic screening
no cardiac comorbidity: asymptomatic
no cardiac comorbidity: symptomatic
idiopathic dilated or hypertrophic cardiomyopathy
- SVT with aberrant conduction
- Electrical artifact
- 2022 AHA/ACC/HFSA guideline for the management of heart failure
- 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
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