eMedicine Specialties > Emergency Medicine > Cardiovascular

Ventricular Tachycardia: Follow-up

Author: Ian S deSouza, MD, Assistant Professor, Department of Emergency Medicine, Kings County Hospital/SUNY Downstate Medical Centers
Coauthor(s): Che' Damon Ward, MD, Staff Physician, Department of Emergency Medicine, State University of New York Health Science Center at Brooklyn
Contributor Information and Disclosures

Updated: Sep 17, 2009

Follow-up

Further Inpatient Care

  • One should admit patients with ventricular tachycardia (VT) to monitored settings as a precaution against recurrent tachydysrhythmia, to facilitate workup for ischemic heart disease, and to allow timely evaluation for definitive electrophysiologic or device therapy.
  • In the past, long-term antidysrhythmic medical therapy was used for suppression of VT. However, several subsets of patients with VT do poorly under such an approach, with frequent recurrence of VT. As a result, cardiologists are increasingly making use of interventional therapy, with devices and procedures designed to abort VT or to remove the dysrhythmogenic foci in the heart. Such interventions include the following:
    • Prophylactic implantation of ICDs
    • Catheter-directed radiofrequency ablation of aberrant conduction pathways
    • In a reported case in the United Kingdom, a patient whose VT was refractory even to ICD prophylaxis underwent bilateral thoracoscopic cervical sympathectomy, which successfully stopped the recurrent VT.5,7

Complications

  • Patients with VT may suffer congestive heart failure (CHF) and its attendant morbidity as a result of hemodynamic compromise.
  • VT may deteriorate to ventricular fibrillation (VF).
  • Consider all patients with VT to have active myocardial ischemia, which should be sought and treated aggressively.

Prognosis

  • If treated rapidly, VT generally has a favorable short-term outcome.
  • Long-term prognosis depends upon the underlying cardiac disease.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to promptly treat hemodynamically compromised patients in a misguided effort to first secure a definite diagnosis
  • Use of verapamil in a wide-complex tachycardia
  • Failure to treat underlying diseases or conditions that may have precipitated the tachydysrhythmia
  • Failure to aggressively assess the patient for myocardial ischemia after initial stabilization
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, William Ernoehazy, Jr, MD, and Keith Marill, MD, and previous editor, Charles V Pollack, Jr, MD, to the development and writing of this article.



More on Ventricular Tachycardia

Overview: Ventricular Tachycardia
Differential Diagnoses & Workup: Ventricular Tachycardia
Treatment & Medication: Ventricular Tachycardia
Follow-up: Ventricular Tachycardia
Multimedia: Ventricular Tachycardia
References
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References

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  3. Marill KA, deSouza IS, Nishijima DK, Stair TO, Setnik GS, Ruskin JN. Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Ann Emerg Med. Mar 2006;47(3):217-24. [Medline].

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Further Reading

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Keywords

ventricular tachycardia, VT, tachydysrhythmia, ventricular ectopic focus, fusion beats, atrioventricular dissociation, AV dissociation, wide QRS complexes, ventricular fibrillation, VF, paroxysmal supraventricular tachycardia, PSVT, torsade de pointes, accelerated idioventricular rhythm, congestive heart failure, pulmonary edema, jugular venous distention,hypotension, CAD, structural heart disease, hypokalemia, hypocalcemia, hypomagnesia, methamphetamine, cocaine, genetic arrhythmia syndrome, cardiac channelopathy

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Contributor Information and Disclosures

Author

Ian S deSouza, MD, Assistant Professor, Department of Emergency Medicine, Kings County Hospital/SUNY Downstate Medical Centers
Ian S deSouza, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Che' Damon Ward, MD, Staff Physician, Department of Emergency Medicine, State University of New York Health Science Center at Brooklyn
Che' Damon Ward, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School
Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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