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Idiopathic (or spontaneous, unknown origin) ventricular tachycardia is a type of ventricular tachycardia (VT) that occurs in patients with structurally normal hearts. I would like to know what the pros and cons are of the three main corrective actions physicians seem to prefer:

  • Verapamil: This seems like the drug of choice, but it tends to cause a drop in blood pressure (BP). If the patient already has a low BP (even if merely because of being young and fit), providers may be reluctant to give this drug fearing a significant drop in BP.

  • Amiodarone: This is a drug with significant toxicity that stays in your system for a long time (weeks to months).

  • Defibrillation: Assuming the patient returns to normal rhythm after the treatment and is not conscious when delivered, it seems to have less side effects than the drugs. I have looked around and have not found any negative long term side effects, but short term (seconds to minutes) there are some risks.

My research so far is inconclusive on what the least harmful long term impact of the three are. I am pretty sure Amiodarone should be a last choice, but unsure about the other two.

What are the pros and cons of these treatment options that a patient diagnosed with idiopathic VT should understand?

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    One minor nit: The term in this situation is cardioversion, not defibrillation. As the word defibrillation implies, that's what's done to ventricular fibrillation, not ventricular tachycardia. – Carey Gregory Jul 8 '15 at 1:57
  • The best treatment for ventricular tachycardia depends upon the underlying cause. A cardiologist with a sub-specialization in cardiac electrophysiology is the specialist who would be most expert at diagnosing and treating this problem. A test called an EPS is usually done to map the arrhythmia. Implantable defibrillators (AICDs) generally do not replace medical therapies and are often used as an adjunct. Amiofarone has important long-term toxicities. – scottb Jul 11 '15 at 5:24
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Please see the following society guidelines first:

The 2006 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) guidelines:

●There is evidence and/or general agreement supporting RF ablation in patients with symptomatic idiopathic VT that is drug-refractory, or in such patients who are intolerant of drugs or do not desire long-term drug therapy.

●The weight of evidence and/or opinion supports the use of beta blockers and/or calcium channel blockers for the treatment of symptomatic idiopathic VT.

●The weight of evidence and/or opinion supports the use of class IC antiarrhythmic drugs as an alternative to or in combination with beta blockers and/or calcium channel blockers for the treatment of symptomatic idiopathic VT that arises from the RVOT. Subsequently, the 2009 European Heart Rhythm Association/Heart Rhythm Society (EHRA/HRS) expert consensus statement recommended catheter ablation in the following patients with idiopathic VT and without structural heart disease [86]:

  1. Severely symptomatic patients with monomorphic VT.
  2. Monomorphic VT in patients in whom antiarrhythmic drugs are not effective, not tolerated, or not desired.
  3. Patients with recurrent sustained polymorphic VT and VF (electrical storm) that is refractory to antiarrhythmic therapy when there is a suspected trigger that can be targeted for ablation

Medical (non-interventional/ablative) management is what is recommended-- especially verapamil or a beta blocker as they are easy to take (pills), and have a pretty nice side effect profile. You can easily find the adverse effects online but they would primarily have to do with heart rate and blood pressure and those are easily monitored.

Ablation is a procedure a cardiology electrophysiologist would do in the "cath lab." This would be in conjunction with an "EP Study" which is an electrophysiology study of the heart to try to find the culprit location that starts the arrythmia. Ablation is sometimes used (see above) in medical-refractory cases.

You can consider amiodarone or other antiarrythmics but they have more side effects. Amiodarone is known to have a very long half life and a long list of side effects which require chronic monitoring (thyroid issues, lung issues, etc.) which is why they are not really first line usually in these cases though can be added on to the first line agents mentioned above.

As an aside:

  • Cardioversion, per the roots of the word, is changing/turning the direction of the heart--> You can think of this as changing the rhythm.
  • Defibrillation is a subset of cardioversion where it is done without any synchronization in cases of ventricular fibrillation. Defibrillation = Asynchronous cardioversion
  • Many medical providers use the term cardioversion in cases of only supraventricular or ventricular tachycardia (in this case usually synchronous) - Cardioversion, as it is changing the rhythm of the heart (electrical or chemical), includes defibrillation but usually is used as a term specific to supraventricular or ventricular tachycardia as defibrillation is more specific when cardioversion is used in ventricular fibrillation.
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    Many medical providers use the term cardioversion in cases of only ventricular tachycardia -- Cardioversion is also the term used when it's applied to SVTs. – Carey Gregory Mar 12 '16 at 21:21

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