MANAGEMENT OF POSTINFARCT VENTRICULAR TACHYCARDIAS

The evaluation and management of postinfarct ventricular tachycardia (VT) has changed dramatically in the past two decades. The introduction and refinement of the implantable cardioverter–defibrillator (ICD) has played a major part in this change, altering both the purpose of patient evaluation and management options. 1,56 Episodes of sustained VT can occur in a variety of clinical settings, the most common of which is the patient who has suffered a myocardial infarction (MI) in the past. In this article, the authors explore the causes and effects of some of these changes and review current strategies for management of the patient with postinfarct VT. Unless otherwise specified, the discussion deals with sustained (i.e., lasting longer than 30 seconds), uniform-morphology VT (each QRS complex identical to all others during the episode). This term is preferred to monomorphic VT, because the latter implies a single electrocardiographic appearance of VT, and most patients with postinfarct VT have multiple uniform electrocardiographic configurations VT.