Circulation, Vol 74, 340-349, Copyright © 1986 by American Heart Association
PT Nguyen, MM Scheinman and J Seger
Forty-five consecutive patients with polymorphous ventricular tachycardia
(PVT) were studied. The arrhythmia proved to be of a drug- related cause in
27 and due to an electrolyte disorder in four patients. Coexistent cardiac
diseases without metabolic or drug-related abnormalities included ischemic
heart disease in three, cardiomyopathy in three, and mitral valve prolapse
in two. PVT was exercise-induced in four and associated with
bradyarrhythmias in two. A prolonged QT or corrected QT interval was
inconsistently related to the occurrence of PVT. In patients in whom PVT
was induced by certain type I drugs, other type I antiarrhythmic drugs were
usually either ineffective or resulted in aggravation of arrhythmia. For
the group as a whole, treatment with lidocaine resulted in inconsistent
beneficial effects, while cardiac pacing was almost universally effective
for those with drug-induced PVT, regardless of the length of the QT
interval. Long-term amiodarone therapy proved safe and effective for 12 of
the 24 patients with drug- induced PVT who required long-term therapy for
their original arrhythmia. We conclude that identification of PVT is the
key clinical issue and that the QT interval is not necessarily the prime
abnormality nor the variable to be considered in predicting success of
therapy. Temporary cardiac pacing appears to be very effective in the
short-term management of these patients. Use of type I antiarrhythmic
agents in patients with drug-induced PVT generally resulted in aggravation
of arrhythmia. In contrast, long-term amiodarone therapy for control of the
original arrhythmia appears to be a promising approach for those with PVT
associated with type I agents.
ARTICLES
Polymorphous ventricular tachycardia: clinical characterization, therapy, and the QT interval
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