Prognosis
Idiopathic ventricular tachycardia
Idiopathic ventricular tachycardia (VT) generally carries a favorable prognosis. In most patients, idiopathic VT is not a progressive condition. The most common symptoms associated with idiopathic VT are palpitations and presyncope; true syncope is uncommon (10% to 20%). Patients presenting with apparent idiopathic VT arising from the right ventricle should undergo a careful evaluation for occult arrhythmogenic right ventricular cardiomyopathy, as ventricular premature complexes (VPC) and VT are frequent early manifestations of this disorder. Frequent or incessant idiopathic VPCs or nonsustained VT have been associated with a reversible, tachycardia-induced cardiomyopathy that regresses following therapy with medications or catheter ablation.[63]
Nonidiopathic VT
In contrast to idiopathic VT, patients who develop sustained VT in the context of left ventricular systolic dysfunction often have reentrant rhythms around myocardial scars. Such reentrant circuits can degenerate to ventricular fibrillation and are associated with a high mortality rate. Implantable cardioverter defibrillator (ICD) implantation provides continuous monitoring of their cardiac rhythm and the capability to terminate VT through overdrive pacing and/or defibrillation. Owing to the unpredictable and rapid onset of sustained VT, and its serious consequence if left untreated, prophylactic ICD therapy has become the most important treatment to reduce mortality among high-risk patients.[7]
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