Monomorphic Ventricular Tachycardia (MVT) Treatment

Introduction

Monomorphic ventricular tachycardia (MVT) is a serious and potentially life-threatening heart rhythm disorder. It originates in the ventricles and is characterized by a rapid, regular heart rate with a uniform QRS complex morphology. Patients with MVT are at risk of developing hemodynamic instability and cardiac arrest, making early recognition and treatment critical.

Causes and Risk Factors

MVT can be caused by various underlying cardiac conditions: - Ischemic heart disease (e.g., previous myocardial infarction with scar-related reentry) - Cardiomyopathies (e.g., dilated or hypertrophic cardiomyopathy) - Electrolyte imbalances (e.g., hypokalemia, hypomagnesemia) - Inherited arrhythmia syndromes (e.g., Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy)

Management and Treatment

Acute Management

1. Assess Hemodynamic Stability

   • If the patient is unstable (e.g., hypotension, altered mental status, chest pain, heart failure signs), immediate synchronized cardioversion is required.
   • If the patient is stable, proceed with pharmacological treatment.

2. Pharmacologic Therapy for Stable MVT

   • Amiodarone (First line, 150 mg IV over 10 minutes, then continuous infusion)
   • Lidocaine (Alternative if amiodarone is ineffective, 1-1.5 mg/kg IV)
   • Procainamide (Another option, especially for stable cases, 20-50 mg/min IV infusion)

3. Correction of Underlying Causes

   • Replete potassium and magnesium, and correct any ischemia or structural heart disease.

Long-term Management

1. Implantable Cardioverter-Defibrillator (ICD)

   • Indicated for patients with MVT due to structural heart disease or history of sudden cardiac arrest.

2. Antiarrhythmic Drugs

   • Beta-blockers (e.g., metoprolol) may be used, especially in patients with ischemic heart disease.
   • Amiodarone or sotalol can be considered for long-term suppression in selected patients.

3. Catheter Ablation

   • Used to eliminate the arrhythmogenic focus in patients with recurrent or drug-refractory MVT.

Conclusion

MVT requires timely recognition and appropriate treatment based on patient stability. Immediate cardioversion is crucial for unstable cases, while antiarrhythmic drug therapy and long-term interventions like ICD or catheter ablation are important for recurrence prevention.

Source recommendations

1. American Heart Association (AHA) Guidelines for the Management of Ventricular Arrhythmias

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
2. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
4. https://www.sciencedirect.com/science/article/pii/S2405500X22010945
5. https://pubmed.ncbi.nlm.nih.gov/29097320/

2. European Society of Cardiology (ESC) Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

1. https://pubmed.ncbi.nlm.nih.gov/36017572/
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
3. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
4. https://pubmed.ncbi.nlm.nih.gov/26320108/
5. https://academic.oup.com/eurheartj/article/36/41/2793/2293363