There are 2 main treatment options for VT in patients without structural heart disease, medications or catheter ablation. RVOT VT medications may be prescribed to suppress VT such as beta-blockers (Metoprolol or Atenolol) or calcium channel blockers (Verapamil or Diltiazem), however these medications only have a 25-50% rate of efficacy. Alternate therapy includes anti arrhythmic medications such as Flecainide, Sotalol and Amiodarone can also be trialed if simple beta-blockers or calcium channel blockers are ineffective. Amiodarone, the most effective drug, has many side effects, which can involve toxicity to the vital organs like the liver, thyroid, lungs, eyes, and skin.
Catheter ablation of RVOT-VT now has cure rates approaching 90%, which makes it a preferable option given the young age of patients with RVOT VT. Ablation of other outflow tract sites such as the aortic cusps has also been successful. Catheter ablation is an excellent choice for patients when medications are not effective, tolerated, or preferred.
Overall this form of VT generally has a much better prognosis than VT in the presence of structural heart disease and is not usually associated with a risk of sudden cardiac arrest. High-risk patients (recurrent syncope and sudden cardiac death survivors) with inherited ion channelopathies predisposing them to VT benefit from the insertion of an Implantable Cardioverter-Defibrillator (ICD).
The aim of this procedure is to target the abnormal focus of the VT by placing a long, thin wire or catheter into the heart chambers through the veins of the leg. When the VT focus is identified, radiofrequency energy is applied to a small area (4 to 5 mm in diameter) to destroy the abnormal tissue. The number of burns required to treat the VT varies among patients.
-Senior Consultant Cardiologist & Electrophysiologist
-Chief, Cardiac Pacing and Arrhythmia Services
-Department of Cardiac Pacing and Electrophysiology
-Apollo Hospitals, Greams Road, Chennai.