( Hence ICDs, even though a technological marvel can not be labelled as curative ! ) Among ICD and RF ablation later could be preferred whenever feasible as it eliminates the arrhythmia, while the former only tackles it only after it occurs. Some times radiofrequency (RF ablation) waves are used to ablate the focus of VT.This is possible only if it occurs close to endocardium as intracardiac catheters do not have access to epicardial focus. These patients will be evaluated for inducibility of VT/VF and if the LV function is poor (EF<30% MADIT 2 criteria ) many would receive implantable cardivertor defibrillator(ICD) or life long anti arrhythmic drugs. Has had an episode of ventricular tachycardia.Patient who have LV dysfunction(Low ejection fraction EF%).But the following will require EP consultations Physicians can treat most of these patients. When to refer a patient with VPD to a electrophysiologist ? * If the patient has systemic disorder like hyperthyroidsm, anemia or underlying heart disease he has to get the specific treatment.Ĭaution:It has become fashionable for the physicians to use powerful antiarrhythmic drugs like amiodarone (Cordarone) liberally in patients with asymptomatic VPDs with structurally normal hearts.this practice must be absolutely avoided as amiodarone is one of most toxic cardiac drugs known with great pro arrhythmic activity. If palpitation is troublesome beta blockers( Propronolol, Atenolol, metoprolol can be used.).Ask them to avoid potential triggers like smoke, alcohol, coffee, tea and related bevarages.Generally do not require any specific drugs in vast majority of individuals.How do you investigate patients with VPDs?Įchocardiogram is usually necessary in most.Įlectrophysiological study in high risk category Some forms of primary electrical disorders of heart( Brugada syndrome, ARVD, CMVT etc).VPDs associated with cardiomyopathy( Ischemic, nonischmic,).VPDs that occur during acute coronary syndrome.What are the most dangerous forms of VPDs ? Further if there is electrolyte abnormality (low potassium), or lack of oxygen it may maintain a VT. A diseased heart may not be able to do so. No one really knows the answer.Most of the NSVT self terminates.A healthy heart some how gets the capacity to self terminate the arrhythmia.The normal LV fails to sustain the abnormal electrical circuit. What prevents a non sustained VT from becoming sustained ? In patients with pre existing heart disease.(Congenital, valvular, myocardial disease) VPDs in patients with dyspnea.(CHF, COPD) What are the VPDs that could be clinically important ? Pregnancy induced VPDs (PIH /Peripartum DCM are rare possibilities).The commonest symptom is palpitation.įriendly VPDs : Some of situations where VPDs are commonly observed and has little significance are. New onset VPDs should be investigated thoroughly. If it occurs in a structurally normal heart it is largely benign. The importance of VPDs do not lie in the number, morphology or frequency but most importantly in the underlying etiology. VT may degenerate into VF ventricular fibrillation in minority( ie cardiac arrest).If it exceeds 30second it called sustained VT.A series of VPD lasting for 30 seconds is called non sustained ventricular tachycardia(NSVT).VPDs in couplets and triplets raise considerable anxiety.( Again it need not be.VPDs that occur in single are less fearsome.( It may not be so.VPDs are often graded according to the count and morphology and frequency.(Lown’s ,Bigger’s grading). In spite of this, the fear of noting a VPD in a given tracing of ECG is genuine both for the patient and his physician.This is because VPDs can be a forerunner of dangerous ventricular arrhythmias. In 24 hour holter recordings it was reported up to 25% of healthy individuals. Ventricular ectopic beats are the most common cardiac electrical abnormality for which cardiologist’s consultation is sought.VPDs are one of most benign observations in ECG and and almost every heart experiences it.
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