Pulseless ventricular tachycardia other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

2017 guidelines from the AHA/ACC/HRS state that MRI, cardiac computed tomography (CT), or radionuclide angiography can be useful in detecting and characterizing underlying heart disease when echocardiography fails to provide an accurate evaluation of LV or RV function and/or assessment of structural changes. Electrophysiologic (EP) testing can be useful when an uncertain diagnosis of sustained monomorphic ventricular tachycardia. An electrophysiological study is especially useful for assessing the risk of ventricular tachycardia in patients with ischemic cardiomyopathy, non-ischemic cardiomyopathy, or adult congenital heart disease who have syncope or other ventricular arrhythmia symptoms and who do not meet indications for a primary prevention implantable cardioverter-defibrillator.

2017 guidelines from the AHA/ACC/HRS state that MRI, cardiac computed tomography (CT), or radionuclide angiography can be useful in detecting and characterizing underlying heart disease when echocardiography fails to provide an accurate evaluation of LV or RV function and/or assessment of structural changes.
Coronary angiography is used in the diagnostic evaluation of ventricular tachycardia in survivors of sudden cardiac death and life-threatening ventricular tachycardia.
Coronary angiography is used to rule out the presence of coronary artery disease in these patients.^[1]
Electrophysiologic (EP) testing can be useful when an uncertain diagnosis of sustained monomorphic ventricular tachycardia.
An electrophysiological study is especially useful for assessing the risk of ventricular tachycardia in patients with certain conditions who have syncope or other ventricular arrhythmia symptoms and who do not meet indications for a primary prevention implantable cardioverter-defibrillator. These conditions include;
- Ischemic cardiomyopathy,
- Non-ischemic cardiomyopathy,
- Adult congenital heart disease.

Class I
“1.In patients who have recovered from unexplained sudden cardiac arrythmis, ”’CT”’ or invasive ”’coronary angiography”’ is useful to confirm the presence or absence of ischemic heart disease and guide decisions for myocardial revascularization. (Level of Evidence B)”

Class IIa
“1.In patients with ischemic cardiomyopathy, non-ischemic cardiomyopathy, or adultcongenital heart disease who have syncope or other ventricular arrhythmia symptoms and who do not meet indications for a primary prevention implantable cardioverter-defibrillator, an electrophysiological study can be useful for assessing the risk of sustained ventricular tachycardia (Level of Evidence B)”

Class III
“1. In patients who meet criteria for implantable cardioverter-defibrillator implantation, an electrophysiological study for the sole reason of inducing ventricular arrhythmia is not indicated for risk stratification (Level of Evidence B)”
“2.A electrophysiological study is not recommended for risk stratification for ventricular arrhythmia in the setting of long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, or early repolarization syndromes (Level of Evidence B)”