Non-sustained ventricular tachycardia in patients with congenital heart disease: An important sign?

Int J Cardiol. 2016 Mar 1;206:158-63. doi: 10.1016/j.ijcard.2016.01.042. Epub 2016 Jan 6.

Abstract

Background: Sustained ventricular tachycardia (susVT) and ventricular fibrillation (VF) are observed in adult patients with congenital heart disease (CHD). These dysrhythmias may be preceded by non-sustained ventricular tachycardia (NSVT). The aims of this study are to examine the 1] time course of ventricular tachyarrhythmia (VTA) in a large cohort of patients with various CHDs and 2] the development of susVT/VF after NSVT.

Methods: In this retrospective study, patients with VTA on ECG, 24-hour Holter or ICD-printout or an out-of-hospital-cardiac arrest due to VF were included. In patients with an ICD, the number of shocks was studied.

Results: Patients (N=145 patients, 59% male) initially presented with NSVT (N=103), susVT (N=25) or VF (N=17) at a mean age of 40 ± 14 years. Prior to VTA, 58 patients had intraventricular conduction delay, 14 an impaired ventricular dysfunction and 3 had coronary artery disease. susVT/VF rarely occurred in patients with NSVT (N=5). Fifty-two (36%) patients received an ICD; appropriate and inappropriate shocks, mainly due to supraventricular tachycardia (SVT), occurred in respectively 15 (29%) (NSVT: N=1, susVT: N=9, VF: N=5) and 12 (23%) (NSVT: N=4, susVT: N=5, VF: N=3) patients.

Conclusions: VTA in patients with CHD appear on average at the age of 40 years. susVT/VF rarely developed in patients with only NSVT, whereas recurrent episodes of susVT/VF frequently developed in patients initially presenting with susVT/VF. Hence, a wait-and-see treatment strategy in patients with NSVT and aggressive therapy of both episodes of VTA and SVT in patients with susVT/VF seems justified.

Keywords: Congenital heart defects; Implantable cardioverter defibrillator; Ventricular tachyarrhythmia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Defibrillators, Implantable
  • Female
  • Heart Defects, Congenital / physiopathology*
  • Heart Defects, Congenital / therapy*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / physiopathology*
  • Tachycardia, Ventricular / therapy*
  • Treatment Outcome