Circulation, Vol 73, 1111-1118, Copyright © 1986 by American Heart Association
BJ Deal, SM Miller, D Scagliotti, D Prechel, JL Gallastegui and RJ Hariman
Since 1974, 24 young patients presenting with ventricular tachycardia and
without clinical evidence of heart disease were evaluated and followed.
Sixteen patients (67%) were symptomatic. Clinical episodes of ventricular
tachycardia were sustained in 18, incessant in four, and nonsustained in
two patients. The rate of tachycardia ranged from 130 to 300 beats/min
(mean = 200 beats/min). Subtle abnormalities of cardiac size or function
were present at cardiac catheterization in 16 of 23 patients (70%). During
electrophysiologic studies, spontaneous ventricular tachycardia was present
in six patients. The clinical ventricular tachycardia was inducible by
programmed stimulation in 13 of 18 patients. The site of origin of
tachycardia based on endocardial mapping in 17 patients was the right
ventricle in 14, the ventricular septum in one, and indeterminate in two
patients. Seventeen patients were treated based on results of short-term
drug testing. During a mean follow-up period of 7.5 years, three patients
died suddenly; none of these patients were receiving antiarrhythmic
medication at the time of death. We conclude that in a young population
without clinical evidence of heart disease, ventricular tachycardia may be
the first manifestation of cardiomyopathy, since at least two-thirds of
these patients have abnormalities at cardiac catheterization. Without
treatment mortality in this population may be as high as 13% over an 8 year
period. Presently we recommend treatment of ventricular tachycardia in any
symptomatic patient, with therapy guided by electrophysiologic and
treadmill testing. In addition, we recommend treatment for any asymptomatic
patient with exercise-related tachycardia, since this group appears to be
at increased risk for sudden death.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Ventricular tachycardia in a young population without overt heart disease
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