Treatment of Sustained Monomorphic Ventricular Tachycardia with Known or Suspected Structural Heart Disease (Haemodynamically Tolerated)
Clinical Scenario
This protocol applies to patients presenting with sustained monomorphic ventricular tachycardia (SMVT) in the setting of known or suspected structural heart disease, where the episode is haemodynamically tolerated — without signs of instability at presentation.
Why Prompt Action Matters
Even when SMVT is initially tolerated, prompt termination is recommended, as rapid haemodynamic deterioration may occur. The presence of structural heart disease is a critical factor that directly informs which pharmacological approach is appropriate.
Management Approach (partial overview)
Intravenous antiarrhythmic therapy is indicated for pharmacological termination — agent selection depends on the patient's comorbidity profile, as specific underlying conditions restrict which agent can safely be used.
Treatment Goal
Termination of ventricular tachycardia with conversion to sinus rhythm.
References
DOI: 10.1093/eurheartj/ehac262
- In patients presenting with a haemodynamically tolerated SMVT and known or suspected SHD, intravenous procainamide should be considered.
- For pharmacological termination of a haemodynamically tolerated VT of unknown aetiology, intravenous procainamide or amiodarone can be used.
- Intravenous procainamide should not be used in patients with severe heart failure, acute MI, and end-stage renal disease.
- Prompt termination of SMVT is recommended even for tolerated SMVT, as rapid haemodynamical deterioration may occur.
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