Nonsustained Ventricular Tachycardia in the Normal Heart: Risk Stratification and Management

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Key points

  • Nonsustained ventricular tachycardia (NSVT) is defined as 3 of more consecutive beats of ventricular origin at a rate of 100 beats/min or greater, lasting less than 30 seconds, usually diagnosed on Holter monitor, telemetry, event recorder, or exercise treadmill test.

  • A nonsustained wide-complex tachycardia should be approached in a systematic fashion, considering alternative diagnoses of artifact, paced rhythm, and supraventricular tachycardia with aberrancy, in addition to NSVT.

  • Distinction

Overview

In approaching the differential diagnosis of NSVT, a stepwise systematic approach is suggested (Fig. 2). First, the consultant should consider that what may be described as NSVT in a consultation request may not represent a ventricular arrhythmia, and alternative diagnoses should be considered. Second, polymorphic ventricular tachycardia (VT) should be distinguished from monomorphic VT because of substantial differences in differential diagnosis, evaluation, and prognosis. Third, potential

Summary

NSVT is a common cause for cardiology and EP consultation and is present in at least 0.5% to 1% of healthy adults with at least 1 ambulatory ECG recording. Establishing the presence or absence of structural or inherited heart disease is a critical step in each patient’s evaluation. This article describes a systematic approach to the evaluation of NSVT. Conditions that may mimic the appearance of NSVT should be excluded, and monomorphic VT and polymorphic VT should be distinguished from one

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    Conflicts of Interest: None.

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