Abstract
The majority of patients who present with ventricular tachycardia have underlying structural heart disease. However, there has been increasing appreciation of the existence of multiple forms of idiopathic ventricular tachycardia with distinct features and unique mechanisms. The most common form of idiopathic ventricular tachycardia originates from the right ventricular outflow tract, is characterized by sensitivity to adenosine, and appears to be due to cyclic AMP-mediated triggered activity. Other forms of idiopathic ventricular tachycardia include intrafascicular left ventricular tachycardia, due to reentry, which is sensitive to verapamil, and automatic, propranolol-sensitive ventricular tachycardia.
Similar content being viewed by others
References and Recommended Reading
Gallavardin L: Extrasystolie ventriculaire à paroxysmes tachycardiques prolongés. Arch Mal Coeur 1922, 15:298–306.
Lerman BB, Belardinelli L, West GA, et al.: Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMPmediated triggered activity. Circulation 1986, 74:270–280.
Lerman BB, Stein K, Engelstein ED, et al.: Mechanism of repetitive monomorphic ventricular tachycardia. Circulation 1995, 92:421–429.
Buxton AE, Marchlinski FE, Doherty JU, et al.: Repetitive, monomorphic ventricular tachycardia: clinical and electrophysiologic characteristics in patients with and without organic heart disease. Am J Cardiol 1984, 54:997–1002.
Rahilly GT, Prystowsky EN, Zipes DP, et al.: Clinical and electrophysiologic findings in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardiogram. Am J Cardiol 1982, 50:459–468.
Callans DJ, Menz V, Schwartzman D, et al.: Repetitive monomorphic tachycardia from the left ventricular outflow tract: electrocardiographic patterns consistent with a left ventricular site of origin. J Am Coll Cardiol 1997, 29:1023–1027.
Lerman BB, Stein KM, Markowitz SM: Mechanisms of idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol 1997, 8:571–583.
Yeh SJ, Wen MS, Wang CC, et al.: Adenosine-sensitive ventricular tachycardia from the anterobasal left ventricle. J Am Coll Cardiol 1997, 30:1339–1345.
Shimoike E, Ohnishi Y, Ueda N, et al.: Radiofrequency catheter ablation of left ventricular outflow tract tachycardia from the coronary cusp: A new approach to the tachycardia focus. J Cardiovasc Electrophysiol 1999, 1:1005–1009.
Lerman BB: Response of nonreentrant catecholamine-mediated ventricular tachycardia to endogenous adenosine and acetylcholine: evidence for myocardial receptor-mediated effects. Circulation 1993, 87:382–390.
Tsuboi N, Ito T, Yamada T, et al.: Idiopathic ventricular tachycardia originating from the left sinus of Valsalva. Implications for radiofrequency catheter ablation [abstract]. PACE 1997, 20:1089.
Stellbrink C, Diem B, Schauerte P, et al.: Transcoronary venous radiofrequency catheter ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 1997, 8:916–921.
Yamaguchi Y, Nogami A, Nito S, et al.: Catheter ablation for ventricular tachycardia from a diverticulum at the right ventricular outflow tract. PACE 1998, 21:1835–1836.
Buxton AE, Waxman HL, Marchlinski FE, et al.: Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation 1983, 68:917–927.
Deal BJ, Miller SM, Scagliotti D, et al.: Ventricular tachycardia in a young population without overt heart disease. Circulation 1986, 73:1111–1118.
Goy JJ, Tauxe F, Fromer M, et al.: Ten-years follow-up of 20 patients with idiopathic ventricular tachycardia. PACE 1990, 13:1142–1147.
Proclemer A, Ciani R, Feruglio GA: Right ventricular tachycardia with left bundle branch block and inferior axis morphology: clinical and arrhythmological characteristics in 15 patients. PACE 1989, 12:977–988.
Gill JS, Prasad K, Blaszyk K, et al.: Initiating sequences in exercise induced idiopathic ventricular tachycardia of left bundle branch-like morphology. PACE 1998, 21:1873–1880.
Markowitz SM, Litvak BL, Ramirez de Arellano EA, et al.: Adenosine-sensitive ventricular tachycardia. right ventricular abnormalities delineated by magnetic resonance imaging. Circulation 1997, 96:1192–1200.
Lerman BB, Wesley RC, DiMarco JP, et al.: Antiadrenergic effects of adenosine on His-Purkinje automaticity: evidence for accentuated antagonism. J Clin Invest 1988, 82:2127–2135.
Han Z, Ferrier GR. Contribution of Na+-Ca2+ exchange to stimulation of transient inward current by isoproterenol in rabbit cardiac Purkinje fibers. Circ Res 1995, 76:664–674.
Lerman BB, Dong B, Stein KM, et al.: Right ventricular outflow tract tachycardia due to a somatic cell mutation in G protein subunit _i2. J Clin Invest 1998, 101:2862–2868. This paper demonstrated that somatic cell mutations can be responsible for some forms of idiopathic RVOT tachycardia.
Gill JS, Ward D, Camm AJ: Comparison of verapamil and diltiazem in the suppression of idiopathic ventricular tachycardia. PACE 1992, 15:2122–2125.
Gill JS, Mehta D, Ward DE, et al.: Efficacy of flecainide, dsotalol, and verapamil in the treatment of right ventricular tachycardia in patients without overt cardiac abnormality. Br Heart J 1992, 68:392–397.
Lerman BB, Stein KM, Markowitz SM, et al.: Ventricular arrhythmias in normal hearts. Cardiol Clin 2000, 18:265–291. This is a comprehensive review of idiopathic ventricular tachycardia, especially with respect to the underlying cellular mechanisms and electrophysiologic diagnosis.
Zipes DP, Foster PR, Troup PJ, et al.: Atrial induction of ventricular tachycardia: Reentry versus triggered activity. Am J Cardiol 1979, 44:1–8.
Belhassen B, Rotmensch HH, Laniado S: Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1981, 46:679–682.
Nakagawa H, Beckman KJ, McClelland JH, et al.: Radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential. Circulation 1993, 88:2607–2617.
Tsuchiya T, Okumura K, Honda T, et al.: Significance of late diastolic potential preceding Purkinje potential in verapamil-sensitive idiopathic left ventricular tachycardia. Circulation 1999, 99:2408–2413. This paper demonstrated the significance of late diastolic potentials in the pathophysiology of intrafascicular ventricular tachycardia.
Suwa M, Yoneda Y, Nagao H, et al.: Surgical correction of idiopathic paroxysmal ventricular tachycardia possibly related to left ventricular false tendon. Am J Cardiol 1989, 64:1217–1220.
Thakur RK, Klein GJ, Sivaram CA, et al.: Anatomic substrate for idiopathic left ventricular tachycardia. Circulation 1996, 93:497–501.
Lin FC, Wen MS, Wang CC, et al.: Left ventricular fibromuscular band is not a specific substrate for idiopathic left ventricular tachycardia. Circulation 1996, 93:525–528.
Okumura K, Matsuyama K, Miyagi H, et al.: Entrainment of idiopathic ventricular tachycardia of left ventricular origin with evidence for reentry with an area of slow conduction and effect of verapamil. Am J Cardiol 1988, 62:727–732.
Ward DE, Nathan AW, Camm AJ: Fascicular tachycardia sensitive to calcium antagonists. Eur Heart J 1984, 5:896–905.
Lin FC, Finley CD, Rahimtoola SH, et al.: Idiopathic paroxysmal ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation: a unique clinical entity with specific properties. Am J Cardiol 1983, 52:95–100.
Okumura K, Yamabe H, Tsuchiya T, et al.: Characteristics of slow conduction zone demonstrated during entrainment of idiopathic ventricular tachycardia of left ventricular origin. Am J Cardiol 1996, 77:379–383.
Lerman BB, Stein KM, Markowitz SM, et al.: Catecholamine facilitated reentrant ventricular tachycardia: uncoupling of adenosine's antiadrenergic effects. J Cardiovasc Electrophysiol 1999, 10:17–26. This paper supports the concept that adenosine-sensitive ventricular tachycardia is a mechanism-specific response for cyclic AMP-mediated triggered activity.
Ohe T, Aihara N, Kamakura S, et al.: Long-term outcome of verapamil-sensitive sustained left ventricular tachycardia in patients without structural heart disease. J Am Coll Cardiol 1995, 25:54–58.
Sung RJ, Shapiro WA, Shen EN, et al.: Effects of verapamil on ventricular tachycardia possibly caused by reentry, automaticity, and triggered activity. J Clin Invest 1983, 72:350–360.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Iwai, S., Lerman, B.B. Management of ventricular tachycardia in patients with clinically normal hearts. Curr Cardiol Rep 2, 515–521 (2000). https://doi.org/10.1007/s11886-000-0036-z
Issue Date:
DOI: https://doi.org/10.1007/s11886-000-0036-z