Ventricular Arrhythmias

Abstract

May 2005

Section 1 Cardiovascular Medicine

VI Ventricular Arrhythmias

Jonathan J. Langberg, M.D.
Professor of Medicine, Cardiology Division, Emory University School of Medicine, and Director, Cardiac Electrophysiology Laboratory, Emory University Hospital

David B. DeLurgio, M.D.
Assistant Professor of Cardiac Electrophysiology, Emory University School of Medicine, and Electrophysiologist, Emory Crawford Long Hospital

Assessment and treatment of ventricular arrhythmias present extraordinary challenges to the clinician. This chapter reviews the three basic mechanisms of ventricular tachycardia—reentry, abnormal automaticity, and triggering—and discusses practical aspects of the evaluation of patients with ventricular arrhythmias, including signal-averaged electrocardiography, microvolt T wave alternans, and electrophysiologic studies. Pharmacologic and nonpharmacologic treatment approaches are summarized, with a table listing the classification of antiarrhythmic drugs and a graph displaying the electrophysiologic characteristics of these agents. Asymptomatic ventricular ectopy, which may be benign in some patients but a harbinger of ventricular fibrillation and sudden cardiac death in others, is discussed, and a section on syncope summarizes the diagnostic evaluation process for determining whether the syncope was induced by ventricular tachycardia. This chapter also covers the evaluation of the patient rescued from cardiac arrest and reviews the clinical signs, diagnostic evaluation, prognosis, and treatment of patients with heritable ventricular arrhythmias, long QT syndrome, Brugada syndrome, and short QT syndrome. A table lists recommendations for treatment with an implantable cardioverter-defibrillator (ICD). This chapter contains 68 references.

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