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  • Review Article
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The diagnosis and management of ventricular arrhythmias

Nature Reviews Cardiology volume 8, pages 311–321 (2011)Cite this article

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Abstract

The term 'ventricular arrhythmias' incorporates a wide spectrum of abnormal cardiac rhythms, from single premature ventricular complexes to sustained monomorphic ventricular tachycardia (VT), polymorphic VT, and ventricular fibrillation. Sustained ventricular arrhythmias are the most common cause of sudden cardiac death. These arrhythmias occur predominantly in patients with structural heart disease, but are also seen in patients with no demonstrable cardiac disease. The diagnosis of VT can be made reliably using electrocardiographic criteria, and a number of algorithms have been proposed. Among patients with VT and a structurally normal heart, the prognosis is usually benign and treatment is predominantly focused on the elimination of symptoms. Patients who have VT in the presence of structural heart disease are often managed with implantable cardioverter-defibrillators. These devices are effective for both primary and secondary prevention of VT and sudden cardiac death. Pharmacological therapy for VT has limited efficacy and is associated with a high incidence of adverse effects. Radiofrequency catheter ablation is useful for controlling recurrent episodes of monomorphic VT; however, research is needed to define the role of catheter ablation in the treatment of other ventricular arrhythmias.

Key Points

  • The diagnosis of ventricular arrhythmias can be accurately made using electrocardiographic algorithms

  • The underlying heart disease determines the prognosis of patients with ventricular arrhythmias

  • In patients without structural heart disease, the treatment of ventricular arrhythmias is focused on the elimination of symptoms

  • In patients with structural heart disease, implantable cardioverter-defibrillators can prevent sudden death

  • Antiarrhythmic therapy has limited efficacy in patients with ventricular arrhythmias and can have substantial adverse effects

  • Catheter ablation is useful to prevent recurrences of ventricular arrhythmia

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Figure 1: 12-lead electrocardiogram of atrial fibrillation with ventricular pre-excitation over a left-sided accessory pathway.
Figure 2: A patient with focal idiopathic ventricular tachycardia.
Figure 3: 12-lead electrocardiogram of broad complex tachycardia.
Figure 4: 12-lead electrocardiogram of fascicular ventricular tachycardia.
Figure 5: Electrocardiographic algorithms of broad complex tachycardia to differentiate between VT and SVT.

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Acknowledgements

K. C. Roberts-Thomson and P. Sanders are supported by the National Heart Foundation of Australia.

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Authors and Affiliations

  1. Department of Cardiology, Cardiovascular Research Center, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, SA, Australia

    Kurt C. Roberts-Thomson, Dennis H. Lau & Prashanthan Sanders

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  1. Kurt C. Roberts-Thomson
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  2. Dennis H. Lau
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  3. Prashanthan Sanders
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Contributions

K. C. Roberts-Thomson researched data for the article. All the authors contributed to the discussion of content, wrote the article, and reviewed/edited the manuscript before submission and after peer-review.

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Correspondence to Prashanthan Sanders.

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Competing interests

K. C. Roberts-Thomson declares having served on the advisory board of St Jude Medical. P. Sanders declares having served on the advisory board of, and having received lecture fees and research funding from, Bard Electrophysiology, Biosense-Webster, Medtronic, Merck Sharp & Dohme, Sanofi-Aventis and St Jude Medical. D. H. Lau declares no competing interests.

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Roberts-Thomson, K., Lau, D. & Sanders, P. The diagnosis and management of ventricular arrhythmias. Nat Rev Cardiol 8, 311–321 (2011). https://doi.org/10.1038/nrcardio.2011.15

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