Sustained ventricular tachycardia in the emergency department

The aim of the study was to evaluate the demographics, haemodynamics, ECG c haracteristics, underlying disease, tachycardia termination and outcome of patients with sustained ventricular tachycardia (VT). We registered 75 pati ents presenting with VT (51 male, median age 63) from December 1993 to Augu st 1998 in our emergency department (ED). Seventeen of these patients were haemodynamically unstable (23%), and 58 patients were stable (77%); there w as no difference in the tachycardia cycle length (median 320 ms) and QRS wi dth (median 140ms) between the two groups; however, five of the seven patie nts with polymorphic VT pattern were in the unstable group. Ischaemic heart disease was the underlying disorder in 57 patients (76%). Acute myocardial infarction (AMI) was present in 12 of the 58 stable (21%) compared to 11 o f the 17 unstable (65%) patients. In three patients (4%) VT terminated spon taneously, in 34 patients (45%) VT was terminated by first-line intravenous drug therapy, and in 38 patients (51%) including all 17 unstable and 22 st able who failed to respond to the intravenous antiarrhythmic therapy challe nge out of 55 patients, VT was terminated by electrical therapy. Within 2 d ays, 48 patients (64%) were transferred to an open ward, 13 (17%) still nee ded intensive care, nine (12%) were discharged to home and five (7%) died. Death occurred due to cardiac failure from AMI with extensive anterior wall infarction in three patients, and due to constrictive pericarditis and reo cclusion of stented LAD each in one patient. At presentation in the emergen cy department, the majority of the patients with VT were haemodynamically s table, thus allowing first-line antiarrhythmic drug administration. However , in the course of the disease, half needed electrical therapy for definiti ve termination of the tachycardia. Therefore, direct current cardioversion must be available in the emergency department. Haemodynamic instability and death occurs significantly more often if VT occurs during the course of AM I. (C) 1999 Elsevier Science Ireland Ltd. Al rights reserved.