Protocolo terapéutico de las taquicardias ventriculares

The major determinant in the acute management of ventricular tachycardia (VT) is the patient's haemodynamic stability, which depends mainly on the tachycardia rate and left ventricular systolic function. Poorly-tolerated tachycardia requires implantable cardioverter defibrillator while well-tolerated tachycardia may be initially treated with antiarrhythmics drugs. The distinction between monomorphic VT and polymorphic VT has important therapeutic implications. Monomorphic VT is due to a myocardial scar that provides the anatomical substrate for a reentrant ventricular circuit. Intravenous antiarrhythmic are the initial treatment of monomorphic VT. Correctable cause underlies usually in polymorphic VT. Electrolytic correction and, in many cases, the temporary pacemaker insertion at high rates of stimulation are indicated in polymorphic VT with prolonged QT interval. Polymorphic VT with a normal QT interval, usually secondary to cardiac ischemia, requires immediate revascularization. Many VT patients carry a defibrillator so it is important to be familiar with its use. Implantation of a defibrillator is cornerstone of the chronic treatment of VT. Implantable cardioverter-defibrillator is indicated in primary prevention of sudden cardiac death in patients with heart failure and severe ventricular dysfunction. For treatment of arrhythmia recurrences, antiarrhythmic drugs and radiofrequency ablation are generally the most useful clinical agents.