Catecholamine-Sensitive Right Ventricular Tachycardia in the Absence of Structural Heart Disease: A Mechanism of Exercise-Induced Cardiac Arrest

Nonsustained ventricular tachycardia (NSVT) is usually a mild entity without serious clinical consequences. Nevertheless, exercise-induced NSVT, and short cycle length of tachycardia, significant arrhythmia burden may predict increased cardiac mortality. NSVT is defined as 3 or more consecutive ventricular beats with a rate over 100 beats/min or more, lasting less than 30 s, that can be diagnosed on the basis of electrocardiography, Holter, telemetry, cardiac monitors or exercise test, after careful wide QRS tachycardia differential diagnostics, artefacts, supraventricular tachycardia with aberration, Hiss-Purkinje block or additional atrio-ventricular pathway descending conduction exclusion. It is necessary to assess homogeneity of the tachycardia (monomorphic or polymorphic), exclude ischemic, structural and genetic heart disease. The treatment is based on observation, farmacotherapy (mainly with beta-blockers, calcium channels blockers and antiarrhythmics) and percutaneous ablation. Implantable cardioverter-defibrillator is not recommended. The prognosis is usually good.

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Faculty Opinions recommendation of Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726122471.793533528 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Long Term Outcomes ◽

Ventricular Tachycardia Ablation ◽

Different Types

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Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

Cardiology Research and Practice ◽

10.1155/2016/7270247 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Daniel H. Wolbrom ◽

Aleef Rahman ◽

Cory M. Tschabrunn

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Ventricular Arrhythmias ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Motor Vehicle ◽

Structural Heart Disease ◽

Chest Injury ◽

Chronic Stage ◽

Chest Wall Injury

Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis) and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

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