Ventricular tachyarrhythmia in structurally normal hearts: Causes, mechanisms, manifestations and treatment options

Rajeev K. Pathak, Kurt Roberts-Thomson, Andrew D. McGavigan

Research output: Chapter in Book/Report/Conference proceedingChapter


Ventricular tachycardia (VT) is generally observed in the setting of structural heart disease. However, in a proportion of patients presenting with VT, the routine diagnostic modalities demonstrate no overt myocardial abnormality. These arrhythmias have been called idiopathic VTs. They consist of various subtypes that have been defined by their anatomic location of origin within the heart (e.g. outflow tract VT, fascicular VT) and/or their underlying mechanism (e.g. adenosine sensitive triggered arrhythmias, verapamil sensitive reentrant arrhythmias). Most patients present at a relatively early age, with typical presentation as paroxysmal ventricular ectopic beats and non-sustained VT. However, sustained tachycardia is not uncommon. While the majority of patients are asymptomatic or mildly symptomatic with palpitations, some will experience frequent and debilitating symptoms. True syncope is infrequent, and these rhythm disorders are rarely life threatening and implantable defibrillators are mainly not indicated. Although lack of structural heart disease is the rule, a subset of patients may develop reversible ventricular dysfunction secondary to incessant or recurring VT. The various treatment options are determined by the burden of the arrhythmias. Beta-blockers and calcium channel blockers are effective in controlling symptoms, however many patients have recurring arrhythmias. Catheter ablation has been traditionally reserved for patients with incapacitating symptoms or progressive ventricular dysfunction. However, as many patients are relatively young, and catheter ablation can be curative in >90% of cases with a low risk (<1%) of serious complications, it is increasingly being offered as a first line treatment in all symptomatic patients. The correct approach to arrhythmia mapping is decided by the 12-lead ECG morphology of the VT. Use of 3-D electroanatomic mapping systems and intra-cardiac echocardiography are helpful in localizing sites for successful ablation.

Title of host publicationTachycardia
Subtitle of host publicationRisk Factors, Causes and Treatment Options
PublisherNova Science Publishers, Inc.
Number of pages22
ISBN (Electronic)9781634633468
ISBN (Print)9781634633031
Publication statusPublished - 1 Oct 2014

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pathak, R. K., Roberts-Thomson, K., & McGavigan, A. D. (2014). Ventricular tachyarrhythmia in structurally normal hearts: Causes, mechanisms, manifestations and treatment options. In Tachycardia: Risk Factors, Causes and Treatment Options (pp. 243-264). Nova Science Publishers, Inc..