eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Ventricular Tachycardia: Follow-up

Author: Mark E Alexander, MD, Assistant Professor, Department of Pediatrics, Children's Hospital of Boston and Harvard Medical School
Coauthor(s): Charles I Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Contributor Information and Disclosures

Updated: Feb 3, 2009

Follow-up

Further Inpatient Care

  • Admit patients with new and unprotected symptoms of apparent cardiac syncope to a monitored setting to ensure their safety during evaluation.
  • Perform intracardiac procedures, some of which may be performed as same-day admissions.
  • Revise or place implantable defibrillators.
  • Initiate antiarrhythmic therapy.

Further Outpatient Care

  • Patients with conditions beyond asymptomatic, isolated, premature ventricular beats should receive episodic monitoring of their clinical status. They may require repeated assessment of ventricular function with echocardiography, repeated Holter or event monitoring, and monitoring for drug effects when drugs are used.
  • Device-based therapy requires a follow-up system to evaluate and manage the consequences and complications of therapy.

Transfer

  • Patients with apparent cardiac syncope and ventricular arrhythmia (VA) require prompt evaluation by a cardiologist.
  • Transfer the patient to a setting that can ensure adequate monitoring, skilled nursing, and an experienced pediatric cardiology team.

Deterrence/Prevention

  • With the possible exceptions of hypertrophic and dilated cardiomyopathy, sudden death remains rare, even in pediatric patients at relatively high risk. The presentation of patients with potentially lethal disease may not be dramatic. One of the most powerful deterrents is for clinicians to recognize that rare, but serious, diagnoses can be identified and treated.
  • Deterrence efforts are aimed primarily at decreasing the consequences of VA (eg, sudden death, tachycardia-mediated cardiomyopathy). For many rhythms, complete suppression is neither warranted nor advisable. Carefully monitor the administration of drugs that affect repolarization (eg, cisapride, major antipsychotics, tricyclic antidepressants [TCAs]) because monitoring may decrease the risk of torsade de pointes in patients taking these medications.
  • Prudent preventive measures for patients with VA include avoiding known triggers and sustained drug use, especially recreational drug use.
  • Therapy with beta-blockers and possibly other medications may help decrease the risk in patients with hypertrophic cardiomyopathy (HCM) and in symptomatic patients with long QT syndrome (LQTS). No particular therapy clearly prolongs survival in high-risk patients with dilated cardiomyopathy or congenital heart disease (CHD).

Complications

  • Complications occur both as a result of the arrhythmia and of the therapy. The most devastating risk is sudden cardiac death (SCD) or aborted sudden death with subsequent hypoxic-ischemic brain injury.
  • Incessant arrhythmia may induce reversible myopathy, and even transient arrhythmic events can produce head injury with sequelae.
  • Therapy poses numerous predictable risks, including proarrhythmia and infection from implantable devices.

Prognosis

  • The prognosis cannot be generalized; it must be individualized and based on the underlying diagnosis.

Patient Education

  • Patients with VA and their families must know how to perform cardiopulmonary resuscitation (CPR) and how to contact local emergency medical services (EMS) to promptly begin therapy or prevent excessive therapy, as warranted. Not all patients need a home ambulatory external defibrillator (AED).
  • Perform family screening when the results of initial patient assessment suggest familial disease (eg, HCM, LQTS).
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Tetralogy of Fallot.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify hypertrophic cardiomyopathy (HCM) or long QT syndrome (LQTS)
  • Failure to identify affected family members with familial diseases (eg, HCM, LQTS)
  • Poor communication of the risk factors to the family and patient
  • Inappropriate choices regarding workup and therapy for many kinds of VT
  • Lack of referral to an experienced center
  • Excessive concern and therapy for low-risk arrhythmia
  • Inappropriate drug selection and/or monitoring
 


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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Further Reading

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Keywords

ventricular tachycardia, nonsustained ventricular tachycardia, accelerated ventricular rhythms, premature ventricular contractions, PVC, repetitive monomorphic ventricular tachycardia, sustained monomorphic ventricular tachycardia, torsade de pointes, ventricular ectopic activity, VEA, ventricular ectopy, ventricular fibrillation, V fib, ventricular flutter, V flutter, ventricular premature beats, ventricular arrhythmia, VA, VT, V tach, sudden cardiac death, syncope, congenital heart disease, long QT syndrome, LQTS, tetralogy of Fallot, ventricular fibrillation, aortic stenosis, hypertrophic cardiomyopathy, HCM, ventricular septal defects, Chagas disease, trypanosomiasis, Brugada syndrome, cocaine, tricyclic antidepressant use, Kawasaki disease, right bundle-branch block, RBBB, right ventricular outflow tract ventricular tachycardia, left bundle-branch block, LBBB

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Contributor Information and Disclosures

Author

Mark E Alexander, MD, Assistant Professor, Department of Pediatrics, Children's Hospital of Boston and Harvard Medical School
Mark E Alexander, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Heart Rhythm Society, and Pediatric Electrophysiology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Charles I Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Christopher Johnsrude, MD, Associate Professor of Pediatrics, Director of Electrophysiology, University of Louisville School of Medicine; Consulting Staff, Pediatric Cardiology Associates, PSC
Christopher Johnsrude, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Hugh D Allen, MD, Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine
Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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