Treatment of Sustained Monomorphic Ventricular Tachycardia Without Significant Structural Heart Disease

This protocol addresses the acute management of sustained monomorphic ventricular tachycardia (SMVT) that presents without haemodynamic instability in patients who have no significant underlying structural heart disease.

Clinical scenario: Haemodynamically tolerated SMVT in the absence of significant structural heart disease. Although the arrhythmia is initially tolerated, prompt termination is recommended — rapid haemodynamic deterioration may occur.

Treatment Goal

Termination of ventricular tachycardia with conversion to sinus rhythm.

Approach

Pharmacological cardioversion using intravenous antiarrhythmic therapy is the primary approach — the specific agent selection and full management algorithm are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehac262

In patients presenting with a haemodynamically tolerated SMVT in the absence of significant SHD, flecainide, ajmaline, or sotalol may be considered.

In patients presenting with a haemodynamically tolerated SMVT in the absence of an established diagnosis, intravenous amiodarone may be considered.

Prompt termination of SMVT is recommended even for tolerated SMVT, as rapid haemodynamical deterioration may occur.

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