Ventricular tachycardia in a young population without overt heart disease BARBARA

Since 1974, 24 young patients presenting with ventricular tachycardia and without clinical evidence of heart disease were evaluated and followed. Sixteen patients (67%) were symptomatic. Clinical episodes of ventricular tachycardia were sustained in 18, incessant in four, and nonsustained in two patients. The rate of tachycardia ranged from 130 to 300 beats/min (mean = 200 beats/min). Subtle abnormalities of cardiac size or function were present at cardiac catheterization in 16 of 23 patients (70%). During electrophysiologic studies, spontaneous ventricular tachycardia was present in six patients. The clinical ventricular tachycardia was inducible by programmed stimulation in 13 of 18 patients. The site of origin of tachycardia based on endocardial mapping in 17 patients was the right ventricle in 14, the ventricular septum in one, and indeterminate in two patients. Seventeen patients were treated based on results of short-term drug testing. During a mean follow-up period of 7.5 years, three patients died suddenly; none of these patients were receiving antiarrhythmic medication at the time of death. We conclude that in a young population without clinical evidence of heart disease, ventricular tachycardia may be the first manifestation of cardiomyopathy, since at least two-thirds of these patients have abnormalities at cardiac catheterization. Without treatment mortality in this population may be as high as 13% over an 8 year period. Presently we recommend treatment of ventricular tachycardia in any symptomatic patient, with therapy guided by electrophysiologic and treadmill testing. In addition, we recommend treatment for any asymptomatic patient with exercise-related tachycardia, since this group appears to be at increased risk for sudden death. Finally, we would seriously consider treating any asymptomatic patient in whom sustained monomorphic ventricular tachycardia can be induced by standard programmed stimulation protocols, although the long-term prognosis in this group is uncertain. Circulation 73, No. 6, 1111-1118, 1986. VENTRICULAR TACHYCARDIA is uncommon in young patients and is usually associated with cardiac tumors in infancy, with congenital heart disease in the older child, or with the prolonged QT syndrome.'-8 Most large series of young patients with ventricular tachycardia but without structural heart disease include individuals with tachycardias of a wide variety of underlying causes, including myocarditis, electrolyte disturbances, and effects of anesthesia.5' 9-'3 Under these circumstances, the ventricular tachycardia occurs transiently, and with treatment of the underlying disorder, usually resolves spontaneously. 13. 14 Idiopathic ventricular tachycardia, which is not associated with organic heart disease or identifiable preFrom the Section of Cardiology, Departments of Pediatrics and Medicine, University of Illinois College of Medicine, Chicago. Supported in part by The Eleanor B. Pillsbury Fellowship, University of Illinois Hospital. Address for correspondence: Barbara J. Deal, M.D., Pediatric Cardiology, University of Illinois Hospital, Box 6998, Chicago, IL 60612. Received Dec. 18, 1985; revision accepted Feb. 20, 1986. Vol. 73, No. 6, June 1986 disposing causes, is widely believed to carry a favorable prognosis.', 13 11-20 However, a recent review of the reported cases cites a mortality of 7%.21 Therefore, the natural history and the need for treatment in these patients remain controversial.5 5. 12. 13. 17. 19, 20-28 The purpose of this article is to report the clinical, cardiac catheterization, and electrophysiologic findings in 24 young patients with ventricular tachycardia and no overt evidence of organic heart disease who were followed at our institution, and to compare these patients with those previously reported.