Cogprints

Ventricular Tachycardia in the Absence of Structural Heart Disease

Srivathsan, Komandoor and Lester, Steven J and Appleton, Christopher P and Scott, Luis R P and Munger, Thomas M (2005) Ventricular Tachycardia in the Absence of Structural Heart Disease. [Journal (Paginated)]

Full text available as:

[img] HTML
82Kb
[img]
Preview
 PDF
814Kb

Abstract

In up to 10% of patients who present with ventricular tachycardia (VT), obvious structural heart disease is not identified. In such patients, causes of ventricular arrhythmia include right ventricular outflow tract (RVOT) VT, extrasystoles, idiopathic left ventricular tachycardia (ILVT), idiopathic propranolol-sensitive VT (IPVT), catecholaminergic polymorphic VT (CPVT), Brugada syndrome, and long QT syndrome (LQTS). RVOT VT, ILVT, and IPVT are referred to as idiopathic VT and generally do not have a familial basis. RVOT VT and ILVT are monomorphic, whereas IPVT may be monomorphic or polymorphic. The idiopathic VTs are classified by the ventricle of origin, the response to pharmacologic agents, catecholamine dependence, and the specific morphologic features of the arrhythmia. CPVT, Brugada syndrome, and LQTS are inherited ion channelopathies. CPVT may present as bidirectional VT, polymorphic VT, or catecholaminergic ventricular fibrillation. Syncope and sudden death in Brugada syndrome are usually due to polymorphic VT. The characteristic arrhythmia of LQTS is torsades de pointes. Overall, patients with idiopathic VT have a better prognosis than do patients with ventricular arrhythmias and structural heart disease. Initial treatment approach is pharmacologic and radiofrequency ablation is curative in most patients. However, radiofrequency ablation is not useful in the management of inherited ion channelopathies. Prognosis for patients with VT secondary to ion channelopathies is variable. High-risk patients (recurrent syncope and sudden cardiac death survivors) with inherited ion channelopathies benefit from implantable cardioverter-defibrillator placement. This paper reviews the mechanism, clinical presentation, and management of VT in the absence of structural heart disease.

Item Type:Journal (Paginated)
Keywords:Ventricular tachycardia; structurally normal heart
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4219
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:16 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Klein LS, Shih HT, Hackett FK, et al. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation 1992;85:1666-74.

2. Miles WM. Idiopathic ventricular outflow tract tachycardia: where does it originate? J Cardiovasc Electrophysiol 2001;12:536-7.

3. Carlson MD, White RD, Trohman RG, et al. Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 1994;24:720-7.

4. Mitrani RD, Klein LS, Miles WM, et al. Regional cardiac sympathetic denervation in patients with ventricular tachycardia in the absence of coronary artery disease. J Am Coll Cardiol 1993;22:1344-53.

5. Rosenbaum MB. Classification of ventricular extrasystoles according to form. J Electrocardiol 1969;2:289-97.

6. Leclercq JF, Rosengarten MD, Attuel P, et al. Idiopathic ventricular extrasystole: right ventricular parasystole not protected from the sinus rhythm [French]? Arch Mal Coeur Vaiss 1981;74:1249-61.

7. Coumel P, Leclercq J-F, Slama R. Repetitive monomorphic idiopathic ventricular tachycardia. In: Zipes DP, Jalife J, editors. Cardiac electrophysiology and arrhythmias. Orlando: Grune & Stratton; 1985. p. 457-68.

8. Proclemer A, Basadonna PT, Slavich GA, et al. Cardiac magnetic resonance imaging findings in patients with right ventricular outflow tract premature contractions. Eur Heart J 1997;18:2002-10.

9. Gaita F, Giustetto C, Di Donna P, et al. Long-term follow-up of right ventricular monomorphic extrasystoles. J Am Coll Cardiol 2001;38:364-70.

10. Lerman BB, Stein KM, Markowitz SM, et al. Ventricular arrhythmias in normal hearts. Cardiol Clin 2000;18:265-91.

11. Buxton AE, Marchlinski FE, Doherty JU, et al. Repetitive, monomorphic ventricular tachycardia: clinical and electrophysiologic characteristics in patients with and patients without organic heart disease. Am J Cardiol 1984;54:997-1002.

12. Hachiya H, Aonuma K, Yamauchi Y, et al. Electrocardiographic characteristics of left ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 2000;23:1930-4.

13. Ouyang F, Fotuhi P, Ho SY, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002;39:500-8.

14. Gill JS, Prasad K, Blaszyk K, et al. Initiating sequences in exercise induced idiopathic ventricular tachycardia of left bundle branch-like morphology. Pacing Clin Electrophysiol 1998;21:1873-80.

15. Globits S, Kreiner G, Frank H, et al. Significance of morphological abnormalities detected by MRI in patients undergoing successful ablation of right ventricular outflow tract tachycardia. Circulation 1997;96:2633-40.

16. Matsuo K, Nishikimi T, Yutani C, et al. Diagnostic value of plasma levels of brain natriuretic peptide in arrhythmogenic right ventricular dysplasia. Circulation 1998;98:2433-40.

17. Pertsov AM, Davidenko JM, Salomonsz R, et al. Spiral waves of excitation underlie reentrant activity in isolated cardiac muscle. Circ Res 1993;72:631-50.

18. Lerman BB, Belardinelli L, West GA, et al. Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity. Circulation 1986;74:270-80.

19. Lerman BB, Dong B, Stein KM, et al. Right ventricular outflow tract tachycardia due to a somatic cell mutation in G protein subunitαi2. J Clin Invest 1998;101:2862-8.

20. Buxton AE, Waxman HL, Marchlinski FE, et al. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation 1983;68:917-27.

21. Iwai S, Lerman BB. Management of ventricular tachycardia in patients with clinically normal hearts. Curr Cardiol Rep 2000;2:515-21.

22. German LD, Packer DL, Bardy GH, et al. Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. Am J Cardiol 1983;52:1202-7.

23. Zipes DP, Foster PR, Troup PJ, et al. Atrial induction of ventricular tachycardia: reentry versus triggered automaticity. Am J Cardiol 1979;44:1-8.

24. Belhassen B, Rotmensch HH, Laniado S. Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1981;46:679-82.

25. Tsuchiya T, Okumura K, Honda T, et al. Effects of verapamil and lidocaine on two components of the re-entry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Am Coll Cardiol 2001;37:1415-21.

26. Nakagawa H, Beckman KJ, McClelland JH, et al. Arrhythmias/Electrophysiology/Pacing/ECGS: radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential. Circulation 1993;88:2607-17.

27. Thakur RK, Klein GJ, Civaram CA, et al. Anatomic substrate for idiopathic left ventricular tachycardia. Circulation 1996;93:497-501.

28. Betts TR, Roberts PR, Allen SA, et al. Radiofrequency ablation of idiopathic left ventricular tachycardia at the site of earliest activation as determined by noncontact mapping. J Cardiovasc Electrophysiol 2000;11:1094-101.

29. Lokhandwala YY, Vora AM, Naik AM, Nabar A, Kavthale S. Dual morphology of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol 1999;10:1326-34.

30. Leenhardt A, Lucet V, Denjoy I, et al. Catecholaminergic polymorphic ventricular tachycardia in children: a 7-year follow-up of 21 patients. Circulation 1995;91:1512-9.

31. Marks AR, Priori S, Memmi M, et al. Involvement of the cardiac ryanodine receptor/calcium release channel in catecholaminergic polymorphic ventricular tachycardia. J Cell Physiol 2002;190:1-6.

32. Priori SG, Napolitano C, Tiso N, et al. Mutations in the cardiac ryanodine receptor gene (hRyR2) underlie catecholaminergic polymorphic ventricular tachycardia. Circulation 2001;103:196-200.

33. Lahat H, Eldar M, Levy-Nissenbaum E, et al. Autosomal recessive catecholamine- or exercise-induced polymorphic ventricular tachycardia: clinical features and assignment of the disease gene to chromosome 1p13-21. Circulation 2001;103:2822-7.

34. Nakajima T, Kaneko Y, Taniguchi Y, et al. The mechanism of catecholaminergic polymorphic ventricular tachycardia may be triggered activity due to delayed afterdepolarization. Eur Heart J 1997;18:530-1.

35. Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002;106:69-74.

36. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome: a multicenter report. J Am Coll Cardiol 1992;20:1391.

37. Brugada P, Brugada R, Brugada J. Sudden death in patients and relatives with the syndrome of right bundle branch block, ST segment elevation in the precordial leads V(1) to V(3) and sudden death. Eur Heart J 2000;21:321-6.

38. Miyazaki T, Mitamura H, Miyoshi S, et al. Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome. J Am Coll Cardiol 1996;27:1061-70.

39. Krishnan SC, Josephson ME. ST segment elevation induced by class IC antiarrhythmic agents: underlying electrophysiologic mechanisms and insights into drug-induced proarrhythmia. J Cardiovasc Electrophysiol 1998;9:1167-72.

40. Ikeda T. Brugada syndrome: current clinical aspects and risk stratificaiton. Ann Noninvasive Electrocardiol 2002;7:251-62.

41. Antzelevitch C, Brugada P, Brugada J, et al. Brugada syndrome: a decade of progress. Circ Res 2002;91:1114-8.

42. Littmann L, Monroe MH, Kerns WP II, et al. Brugada syndrome and “Brugada sign”: clincial spectrum with a guide for the clinician. Am Heart J 2003;145:768-78.

43. Moss AJ. Long QT syndrome. JAMA 2003;289:2041-4.

44. Schwartz PJ, Priori SG, Spazzolini C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific trigger for life-threatening arrhythmias. Circulation 2001;103:89-95.

45. Zareba W, Moss AJ, Schwartz PJ, et al, for the International Long-QT Syndrome Registry Research Group. Influence of genotype on the clinical course of the long-QT syndrome. N Engl J Med 1998;339:960-5.

46. Roden DM, Anderson ME. The pause that refreshes, or does it? Mechanisms in torsades de pointes. Heart 2000;84:235-7.

47. Moss AJ, Zareba W, Hall WJ, et al. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 2000;101:616-23.

48. Compton SJ, Lux RL, Ramsey MR, et al. Genetically defined therapy of inherited long-QT syndrome: correction of abnormal repolarization by potassium. Circulation 1996;94:1018-22.

49. Zareba W, Moss AJ, Daubert JP, et al. Implantable cardioverter defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol 2003;14:337-41.

50. Mansfield RJ, Thomas RD. Recurrent syncope: drug induced long QT syndrome. Postgrad Med J 2001;77:344, 352-3.

Metadata

Repository Staff Only: item control page

Cogprints is powered by EPrints 3 which is developed by the School of Electronics and Computer Science at the University of Southampton. More information and software credits.