Clinical management of patients with nonsustained ventricular tachycardia: what do we really know?
The management of patients with nonsustained ventricular tachycardia remains one of the most difficult tasks facing the practicing cardiologist. This common arrhythmia is a marker for death and morbid events in patients with a variety of forms of heart disease, but there is as yet no conclusive evidence that its suppression confers benefit. This paper will review the methods now available to risk stratify patients who have repetitive forms on electrocardiographic monitoring, their advantages and limitations. We will also review some of the trials which have attempted to prove that arrhythmia suppression improves survival. Finally, we will try to provide some recommendations to the clinician, based on what we know about this common arrhythmia. Though we will concentrate our attention on ischemic heart disease, we will briefly discuss the preferred management of patients with other forms of heart disease in whom the presence of nonsustained ventricular tachycardia has prognostic significance. We would like to emphasize that this is a rapidly changing field, and that treatment approaches will necessarily change, based on the results of ongoing clinical trials. The physician must not rigidly adhere to any treatment policy, but rather alter his or her approach based on the development of new information.