Exercise-Induced Sustained Ventricular Tachycardia without Structural Heart Disease: A Case Report

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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Value of signal averaged electrocardiogram in predicting structural heart disease in patients with sustained ventricular tachycardia

Journal of the American College of Cardiology ◽

10.1016/0735-1097(90)92381-b ◽

1990 ◽

Vol 15 (2) ◽

pp. A166

Author(s):

Henry Hsia ◽

Peter J. Wells ◽

William H. Black ◽

Martha Solo ◽

Mark S. Kremers

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Sustained Ventricular Tachycardia

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Exercise Induced Non-Sustained Ventricular Tachycardia and Indication for Invasive Management

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s8504 ◽

2011 ◽

Vol 5 ◽

pp. CMC.S8504 ◽

Cited By ~ 2

Author(s):

Shahriar Dadkhah ◽

Samaneh Dowlatshahi ◽

Korosh Sharain ◽

Roza Sharain

Keyword(s):

Cardiovascular Disease ◽

Ventricular Tachycardia ◽

Case Report ◽

Coronary Artery ◽

Sustained Ventricular Tachycardia ◽

Coronary Artery Lesion ◽

Stress Echo ◽

Considerable Debate ◽

Exercise Induced ◽

Invasive Management

Diagnostic stress echo testing is commonly performed in patients with known or suspected cardiovascular disease. There has been considerable debate in management of exercise induced non-sustained ventricular tachycardia (NSVT). In this case report, we present our experience with a case of exercise induced NSVT, and subsequent angiographically significant left anterior descending (LAD) coronary artery lesion.

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Sustained ventricular tachycardia in structural heart disease

Cardiology Journal ◽

10.5603/cj.a2014.0069 ◽

2015 ◽

Vol 22 (1) ◽

pp. 12-24 ◽

Cited By ~ 5

Author(s):

Claudio Hadid

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Sustained Ventricular Tachycardia

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Case Report: A Rare Complication Following Catheter Ablation of Scar-Related Ventricular Tachycardia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.748194 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoyong Xu ◽

Ming Ye ◽

Yaxun Sun ◽

Qiang Liu ◽

Fusheng Ma ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Case Report ◽

Heart Function ◽

Rare Complication ◽

Structural Heart Disease ◽

Cardiac Resynchronization ◽

Qrs Complex ◽

Substrate Modification ◽

Short Period

Background: The substrate for ventricular tachycardia (VT) in patients with structural heart disease is usually complex and often requires extensive ablation. As a result, the incidence of major procedure-related complications has been reported to be higher when compared to patients without structural heart disease. In this study, we present a rare complication after extensive substrate modification of scar-related VT.Case: A 65-year-old man with ischemic cardiomyopathy was referred to the electrophysiology laboratory for radiofrequency ablation of VT following repetitive implantable cardioverter defibrillator shocks within a short period. As with hemodynamic intolerance of induced VT, an approach involving extensive endocardial substrate modification to reduce the arrhythmogenicity of the scars was adopted. After the procedure, the heart function of the patient deteriorated significantly. The postprocedural ECG showed a bizarre, extremely wide surface QRS complex (360 ms), termed as homologous ventricular separation. The pronounced dyssynchrony of the ventricle was corrected by an upgrade to cardiac resynchronization therapy with defibrillation (CRT-D). As a result, the symptoms of the patient improved significantly. The width of the intrinsic QRS complex was not recovered during an 18-month follow-up.Conclusion: Homologous ventricular separation is a rare arrhythmia, manifested as two separated QRS waves. This case report demonstrates, for the first time, that homologous ventricular separation may occur after extensive substrate modification of scar-related VT. CRT-D can correct the dyssynchronous ventricle caused by homologous ventricular separation.

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Classification and treatment of non-sustained ventricular tachycardia

ESC CardioMed ◽

10.1093/med/9780198784906.003.0535 ◽

2018 ◽

pp. 2259-2265

Author(s):

Alfred E. Buxton

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Total Mortality ◽

Structural Heart Disease ◽

Clinical Situation ◽

Sustained Ventricular Tachycardia ◽

Death Risk ◽

Sudden Cardiac Death Risk

Non-sustained ventricular tachycardia (NSVT) is classified in a variety of ways, depending on the clinical situation. The two primary distinctions are whether the arrhythmia occurs in the presence or absence of structural heart disease, and whether or not the arrhythmia causes symptoms. The prevalence of NSVT is highest in patients with structural heart disease. NSVT in patients with heart disease rarely causes symptoms, but may be associated with increased total mortality and sudden cardiac death risk. However, sudden cardiac death risk is usually not elevated out of proportion to the increased total mortality risk, suggesting that NSVT is merely a marker of sicker patients, rather than having a mechanistic relation to arrhythmias causing cardiac arrest. Furthermore, no trial has demonstrated that suppression of NSVT reduces mortality. In contrast, patients with symptoms due to NSVT usually do not have underlying structural heart disease. In these patients, treatment may be necessary to relieve symptoms and improve quality of life. Appropriate treatment of NSVT in this setting also does not improve mortality, because NSVT in the absence of structural heart disease is not associated with increased mortality or sudden death risk (excepting patients with ion channelopathies, such as long QT syndrome). The exception to this rule is the recognition that ventricular dysfunction may be caused by frequent or incessant episodes of NSVT. In this case, treatment of the arrhythmia may not only improve symptoms, but presumably also improve survival.

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Electrophysiological study

The ESC Textbook of Sports Cardiology ◽

10.1093/med/9780198779742.003.0014 ◽

2019 ◽

pp. 116-119

Author(s):

Matthias Antz

Keyword(s):

Atrial Fibrillation ◽

Risk Assessment ◽

Heart Disease ◽

Ventricular Tachycardia ◽

Brugada Syndrome ◽

Electrophysiological Study ◽

Structural Heart Disease ◽

Sustained Ventricular Tachycardia ◽

Ectopic Beats

An electrophysiological (EP) study is performed for diagnostic reasons, for risk assessment, and for therapy of arrhythmias. It can be useful in athletes with palpitations or documented arrhythmias of unclear origin, in non-sustained ventricular tachycardia, structural heart disease, or electrical abnormalities such as the Brugada syndrome, and for treatment of ectopic beats, supraventricular or ventricular tachycardia, and atrial fibrillation.

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