VT that is associated with loss of consciousness or hypotension (low blood pressure) is a medical emergency requiring immediate defibrillation. (shock) Survival depends on prompt attention.
If VT is sustained but the patient is tolerating it well, IV medications may be tried. The most commonly used medications are amiodorone and lidocaine. Magnesium may also be given. If these are not helpful then a shock may be necessary.
Non sustained VT can be treated on a chronic basis with medication. Some commonly used medications are sotolol, amiodorone, and mexiletine. Most medications require initiation in the hospital. This is because they have the potential to cause other abnormal heart rhythms.
Implantable cardiac defibrillators can be lifesaving treatment for patients with VT. They are small devices implanted under the skin of the chest. They are connected to leads that go into the heart. The ICD monitors the patient's heart rhythm continuously and can either pace or shock the patient out of VT.
Getting an ICD is a life changing event. There are physical and psychological adjustments to be made but patients with ICDs often live perfectly normal lives. Post traumatic stress can be a huge problem for those who have experienced ICD shocks.
There have been several lead recalls associated with ICDs and leads. Most recently, Medtronic recalled the Fidelis lead (this is the one that caused all my problems) because there was an increased risk of fracture and inappropriate shocks as well as withholding of needed shocks. More information about this can be found here.
Rarely the ICD lead can irritate the heart where it is inserted and actually cause the patient to have VT. Patients who have uncontrollable VT should have this considered as a possible cause.
Patients who have a history of VT who have existing heart disease may be candidates for ICDs. ICDs have been shown to be far superior over antiarrhythmic medications in improving survival in high risk patients.
Ablation is a procedure where the pathway of the heart where the VT originates is burned. The patient is taken to the EP lab and catheters are inserted into the groin and fed into the heart. The patient's heart rhythm is "mapped" and the spot where the VT comes from can often be identified and a small area of the heart muscle is burned. This can be curative in some cases. Patients who have idiopathic VT who have normal hearts will often respond very well to ablation. Patients who have impaired heart function may not be good candidates for this procedure because of the decreased chance of success. VT ablations are only available in specialized centers.
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