Ventricular tachycardia monomorphic

Misra D, Van Tosh A, Schweitzer P. Adenosine indnced monomorphic ventricular tachycardia. Pacing Qin Electrophysiol 2000 23(6) 1044-6. 

Pinar Bermudez E, Garcia-Alberola A, Martinez Sanchez J, Sanchez Munoz JJ, Valdes Chavarri M. Spontaneous sustained monomorphic ventricular tachycardia after administration of ajmaline in a patient with Brugada syndrome. Pacing Clin Electrophysiol 2000 23(3) 407-9. 

A 71-year-old Japanese man with bouts of sustained monomorphic ventricular tachycardia, in whom non-sustained polymorphic ventricular tachycardia was induced by rapid pacing during electrophysiological studies, was given amiodarone and developed three different types of sustained monomorphic ventricular... 

Symptomatic bradycardia, junctional rhythm, non-sustained and/or monomorphic ventricular tachycardia... 

A 35-year-old woman taking disopyramide phosphate modified-release capsules 150 mg qds was given azithromycin 500 mg initially and 250mg/day thereafter (36). In 11 days she developed malaise, light-headedness, and urinary retention. After the insertion of a urinary catheter she developed a monomorphic ventricular tachycardia with left bundle branch block. She was successfully cardioverted and the electrocardiogram... 

In patients with sustained monomorphic ventricular tachycardia inducible by programmed electrical stimulation, who had previously been unsuccessfully treated with... 

Bashir Y, Thomsen PE, Kingma JH, Moller M, Wong C, Cobbe SM, Jordaens L, Campbell RW, Rasmussen HS, Camm AJ. Electrophysiologic profile and efficacy of intravenous dofetilide (UK-68,798), a new class III antiarrhythmic drug, in patients with sustained monomorphic ventricular tachycardia. Dofetilide Arrhythmia Study Group. Am J Cardiol 1995 76(14) 1040-4. 

A monomorphic sustained ventricular tachycardia does not occur frequently in ACS, especially in patients without prior infarctions. However, it has been shown to have worse prognosis in 1-year follow-up period than that of patients with primary VF (Newby et al., 1998). It is partly related to prior infarction scar, which explains its lower incidence following a first myocardial infarction (Fiol, 2001 Mont et al., 1996). Rarely, it may appear during the course of a significant and sustained coronary spasm. 

Mont L, Cinca J, Blanch P et al. Predisposing factors and prognostic value of sustained monomorphic ventricular tachycardia in the early phase of acute myocardial infarction. J Am Coll Cardiol 1996 28 1670. 

Life-threatening proarrhythmia generally takes two forms sinusoidal or incessant monomorphic ventricular tachycardia (type Ic agents) and torsade de pointes (type la or III agents and others such as select antihistamines). 

Acute treatment of TdP is different from treatment for the more common acute monomorphic ventricular tachycardia (or polymorphic VT with a normal QT interval). For an acute episode of TdP, most patients will require and respond to DCC. However, TdP tends to the paroxysmal in nature and often will recur rapidly after countershock. Therefore, after the initial restoration of a stable rhythm, therapy designed to prevent recurrences of TdP should be instituted. Drugs that further prolong repolarization such as intravenous procainamide are absolutely contraindicated. Lidocaine usually is inef-... 

Gorgels A, van den Dool A, Hofs A, et al. Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. Am J Cardiol 1996 78 43-46. 

The introduction and manipulation of pacing leads are frequently associated with both tachyarrhythmias and bradyarrhythmias as a lead negotiates the chambers of the right heart. Ventricular tachycardia is extremely common as the pacing electrode or guidewire contacts the right ventricular myocardium. Simple withdrawal of these objects usually terminates the arrhythmia. In extreme cases, sustained monomorphic ventricular tachycardia and even ventricular fibrillation may occur. Some institutions have instituted a policy of placing external defibrillation pads prophylactically in anticipation of required cardioversion. 

Although feasible and potentially beneficial for patients without structural heart disease and monomorphic ventricular arrhythmias, radiofrequency catheter has questionable benefit to reduce adverse outcomes in patients with structural heart disease. This approach is really meant to prevent inducible, well-tolerated ventricular tachycardia from becoming a clinical problem in these patients, but not to prevent death (138-141). 

Ablation may treat bundle-branch reentry and fascicular forms of ventricular tachycardia effectively (142-144). Ablation of Purkinje fibers may reduce the risk of idiopathic ventricular fibrillation initiated by a PVC (76) and some forms of ventricular tachycardia (145). Substrate modification can reduce specific forms of recurrent monomorphic ventricular tachycardias in patients with structural heart disease (138,146-149), particularly if the patient is having storms of tachycardia Therefore, occasionally, ablation performed during electrophysiology testing can modify the ventricular tachycardia recurrences... 

MADIT was the first randomized trial to show that the ICD, used as a prophylactic, can reduce the risk of death in high-risk patients. The MADIT assessed patients who had coronary artery disease and a prior Q-wave myocardial infarction. To be included, patients had to have (a) asymptomatic nonsustained ventricular tachycardia recorded on a 24-h Hotter monitor, (b) a left ventricular ejection fraction of < 0.35 and, (c) inducible sustained monomorphic ventricular tachycardia or ventricular fibrillation not suppressed by procainamide at electrophysiology testing. 

A 45-year-old man with no history of cardiac disease had a seizure. His electrocardiogram was normal He then suddenly developed a monomorphic wide-complex ventricular tachycardia for which he was given lidocaine 70 mg followed by a continuous infusion of 1 mg/minute. This led to ST segment elevation in leads Vl-3, which persisted even 1 year later. There was no evidence of myocardial infarction and he had no chest pain. He was genotyped and the sodium channel mutation was discovered. 

A 45-year-old black man with no history of cardiac disease had a seizure associated with a monomorphic broad-complex ventricular tachycardia. He was given lidocaine 70 mg followed by a continuous infusion of 1 mg/minute, which... 

Stable monomorphic or polymorphic ventricular tachycardia algorithm... 

Cardioversion is an appropriate, immediate treatment for stable ventricular tachycardia (VT). Alternatives to this treatment depend on the type of VT, the patient s cardiac function, and the configuration of the QT interval. In monomorphic VT, QRS complexes keep the same form or appearance. In polymorphic VT, QRS complexes occur in more than one form, varying in appearance. 

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