Idiopathic Ventricular Tachycardia: Good Prognosis but Debilitating Symptoms

Gelu Simu, Mihai Puiu, Gabriel Cismaru, Gabriel Gusetu, Dana Pop, Dumitru Zdrenghea, Radu Rosu

International Journal of Biomedicine. 2022;12(4):667-670.
DOI: 10.21103/Article12(4)_CR1
Originally published December 5, 2022


Ventricular arrhythmias may occur in patients without anatomical heart abnormalities, a condition that is known as idiopathic ventricular arrhythmias. The most common form originates at the level of the outflow tracts. It can manifest as PVCs, non-sustained ventricular tachycardia (VT), and sustained VT. A 52-year-old female patient was admitted for 2 episodes of syncope related to a high burden of premature ventricular contractions (PVCs) and several episodes of VT with the same QRS morphology as the PVCs. A diagnosis of sustained monomorphic VT was formulated in a patient with no structural heart disease and a normal ejection fraction. Antiarrhythmic drugs such as metoprolol, propafenone, and amiodarone failed to reduce the number of PVCs, hence catheter ablation was suggested to the patient. The patient consented to the treatment, and following catheter ablation, the patient no longer experienced syncope. The 24-hour Holter ECG monitoring revealed no PVCs or VTs. PVCs and VTs from the RVOT are typically benign with a good prognosis. Catheter ablation should be employed as the definitive treatment for RVOT-VT, as our case demonstrates only partial response to antiarrhythmic drugs.

catheter ablation • ventricular tachycardia • premature ventricular contractions • syncope • RVOT

1. Jadonath RL, Schwartzman DS, Preminger MW, Gottlieb CD, Marchlinski FE. Utility of the 12-lead electrocardiogram in localizing the origin of right ventricular outflow tract tachycardia. Am Heart J. 1995 Nov;130(5):1107-13. doi: 10.1016/0002-8703(95)90215-5.
2. Kamakura S, Shimizu W, Matsuo K, Taguchi A, Suyama K, Kurita T, Aihara N, Ohe T, Shimomura K. Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation. 1998 Oct 13;98(15):1525-33. doi: 10.1161/01.cir.98.15.1525.
3. Joshi S, Wilber DJ. Ablation of idiopathic right ventricular outflow tract tachycardia: current perspectives. J Cardiovasc Electrophysiol. 2005 Sep;16 Suppl 1:S52-8. doi: 10.1111/j.1540-8167.2005.50163.x.
4. Gard JJ, Asirvatham SJ. Outflow tract ventricular tachycardia. Tex Heart Inst J. 2012;39(4):526-8.
5. Rosu R, Cismaru G, Muresan L, Puiu M, Andronache M, Gusetu G, Pop D, Mircea PA, Zdrenghea D. Catheter ablation of ventricular tachycardia related to a septo-apical left ventricular aneurysm. Int J Clin Exp Med. 2015 Oct 15;8(10):19576-80.
6. Zeppenfeld K, Wijnmaalen AP, Ebert M, Baldinger SH, Berruezo A, Catto V, Vaseghi M, Arya A, Kumar S, de Riva M, Deneke T, Gaspar T, Soejima K, van Rein N, Tedrow UB, Piorkowski C, Shivkumar K, Carbucicchio C, Hindricks G, Stevenson WG. Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia. J Am Coll Cardiol. 2022 Sep 13;80(11):1045-1056. doi: 10.1016/j.jacc.2022.06.035.
7. Namboodiri N, Francis J. Ventricular arrhythmias in hypertrophic cardiomyopathy--can we ever predict them? Indian Pacing Electrophysiol J. 2010 Mar 5;10(3):112-4.
8. Gabriel C, Puiu M, Rosu R, Muresan L, Rancea R, Gusetu G, Pop D, Zdrenghea D. Intracardiac ultrasound to detect aneurysm in arrhythmogenic right ventricular dysplasia/cardiomyopathy. Oxf Med Case Reports. 2018 Jan 25;2018(1):omx088. doi: 10.1093/omcr/omx088.
9. Cismaru G, Zgiia A, Istratoaie S, Puiu M, Muresan L, Cismaru A, et al. RVOT ventricular tachycardia ablation in a patient with atrial septal defect: a case report. Int J Clin Exp Med. 2020;13(10):8118-8126.
10. Viskin S, Rosso R, Rogowski O, Belhassen B. The "short-coupled" variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia? J Cardiovasc Electrophysiol. 2005 Aug;16(8):912-6. doi: 10.1111/j.1540-8167.2005.50040.x.
11. Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, et al. Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J Am Coll Cardiol. 2009 Aug 4;54(6):522-8. doi: 10.1016/j.jacc.2009.03.065.
12. Shimizu W. Arrhythmias originating from the right ventricular outflow tract: how to distinguish "malignant" from "benign"? Heart Rhythm. 2009 Oct;6(10):1507-11. doi: 10.1016/j.hrthm.2009.06.017.
13. Buxton AE, Waxman HL, Marchlinski FE, Simson MB, Cassidy D, Josephson ME. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation. 1983 Nov;68(5):917-27. doi: 10.1161/01.cir.68.5.917.
14. Mont L, Seixas T, Brugada P, Brugada J, Simonis F, Rodríguez LM, Smeets JL, Wellens HJ. Clinical and electrophysiologic characteristics of exercise-related idiopathic ventricular tachycardia. Am J Cardiol. 1991 Oct 1;68(9):897-900. doi: 10.1016/0002-9149(91)90405-a.

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Received September 29, 2022.
Accepted November 3, 2022.
©2022 International Medical Research and Development Corporation.