From the Guidelines
Non-sustained ventricular tachycardia (NSVT) can present with symptoms such as palpitations, dizziness, lightheadedness, shortness of breath, chest discomfort or pain, fatigue, and near-syncope, although some patients may be asymptomatic. According to the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, NSVT is defined as three or more consecutive ventricular beats at a rate >100 beats per minute lasting less than 30 seconds. The severity of symptoms typically depends on the rate of the tachycardia, its duration, underlying heart condition, and the patient's overall health status. Some key points to consider include:
- Patients with structural heart disease or cardiomyopathy may experience more pronounced symptoms even with brief episodes of NSVT.
- NSVT can be a marker for increased risk of sustained ventricular arrhythmias in certain populations, particularly those with underlying heart disease.
- Any patient experiencing these symptoms should seek medical evaluation promptly, as proper diagnosis through ECG monitoring or Holter monitoring is essential for appropriate management. It's also worth noting that the European Society of Cardiology has provided guidelines on indications for implantable cardioverter-defibrillator (ICD) therapy, which include NSVT in certain clinical contexts 1. However, the most recent and highest quality study, the 2017 AHA/ACC/HRS guideline 1, provides the most relevant information for managing NSVT and preventing sudden cardiac death. Therefore, it is crucial to prioritize the management of underlying heart disease and to consider the patient's overall health status when evaluating and treating NSVT.
From the Research
Symptoms of Non-Sustained Ventricular Tachycardia (VT)
The symptoms associated with non-sustained VT can vary, but common presentations include:
- Palpitations
- Near-syncope
- Dizziness
- Skipped beats
- Chest pain
- Dyspnea 2 In some cases, non-sustained VT can be asymptomatic, especially if the burden percentage is low 2.
Diagnosis and Presentation
Non-sustained VT can be difficult to diagnose, as it may not be identified on electrocardiogram (ECG) by the time the patient arrives at the emergency department 2.
- Prolonged cardiac monitoring
- Mobile cardiac telemetry (MCT)
- Internal loop recorder placement may be required to identify non-sustained VT 2. The diagnosis of VT is usually made based on electrocardiographic data, most commonly 12-lead echocardiography (ECG), as well as supportive cardiac telemetric monitoring 3.
Management Considerations
Treatment for non-sustained VT is often targeted toward symptoms and may consist of: