Idiopathic Ventricular Tachycardia: Good Prognosis but Debilitating Symptoms

Ventricular arrhythmias may occur in patients without anatomical heart abnormalities, a condition that is known as idiopathic ventricular arrhythmias. The most common form originates at the level of the outflow tracts. It can manifest as PVCs, non-sustained ventricular tachycardia (VT), and sustained VT. A 52-year-old female patient was admitted for 2 episodes of syncope related to a high burden of premature ventricular contractions (PVCs) and several episodes of VT with the same QRS morphology as the PVCs. A diagnosis of sustained monomorphic VT was formulated in a patient with no structural heart disease and a normal ejection fraction. Antiarrhythmic drugs such as metoprolol, propafenone, and amiodarone failed to reduce the number of PVCs, hence catheter ablation was suggested to the patient. The patient consented to the treatment, and following catheter ablation, the patient no longer experienced syncope. The 24-hour Holter ECG monitoring revealed no PVCs or VTs. PVCs and VTs from the RVOT are typically benign with a good prognosis. Catheter ablation should be employed as the definitive treatment for RVOT-VT, as our case demonstrates only partial response to antiarrhythmic drugs.