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Ventricular Tachycardia and Sudden Cardiac Death 

Ventricular Tachycardia and Sudden Cardiac Death
Chapter:
Ventricular Tachycardia and Sudden Cardiac Death
Author(s):

Lars Eckardt

, Günter Breithardt

, and Stefan Hohnloser

DOI:
10.1093/med/9780199566990.003.030
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date: 22 August 2019

Sudden cardiac death (SCD) continues to be a leading cause of death in Western countries, most often caused by ventricular tachyarrhythmias, such as ventricular tachycardia (VT) or fibrillation (VF), in the setting of structural heart disease. Ventricular arrhythmias can also be a mechanism of sudden death in patients with structurally normal hearts (e.g. ion channel disorders such as long or short QT syndrome, Brugada syndrome). Risk stratification for SCD remains a major challenge despite the development of numerous non-invasive risk factors. In contrast to VF, VTs are relatively organized tachyarrhythmias with discrete QRS complexes. They can be either sustained or non-sustained, and can be monomorphic or polymorphic. Polymorphic ventricular tachyarrhythmias tend to be faster and less stable than monomorphic. The correct diagnosis of a VT remains a challenge despite established criteria for the differentiation of ventricular from supraventricular tachycardia (SVT) with aberrant conduction. A re-entry mechanism accounts for the majority of ventricular tachyarrhythmias in patients with structural heart disease. The spectrum of therapies for VTs includes drug therapy, device implantation, and ablation techniques. The implantable defibrillator is an effective treatment modality not only for secondary, but also for primary prevention of SCD in selected patient populations. The management challenge is to deal both with the VT as the presenting symptom, and the SCD risk that may be the consequence of the arrhythmogenic substrate. As only a minority of victims of cardiac arrest survive to receive secondary preventive therapy, recent years have seen strong efforts to improve cardiopulmonary resuscitation. Probably the most important aspect in this regard is the development of the automatic external defibrillator, which effectively improves the outcome of victims of cardiac arrest....

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