Ventricular tachycardia: What can help?

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People with severe heart disease have a higher risk of ventricular tachycardia (VT or V-tach). Potentially life-threatening complications of VT episodes can be prevented with an implanted defibrillator. They can also be prevented with cardiac ablation and medication.

Ventricular tachycardia is a heart rhythm disorder (arrhythmia) where the heart beats too fast. Possible complications include circulatory failure, fainting and sudden cardiac death. The risk of these complications is higher if the heart muscle is weak (for instance, as the result of a ) or if you have already had ventricular tachycardia. Then preventive measures are recommended.

The main way to prevent sudden cardiac death is with an implantable cardioverter-defibrillator (ICD). Cardiac ablation is also an option. This procedure involves destroying (ablating) the heart tissue that is causing the irregular heartbeat. Medication can be used too. People with ventricular tachycardia often have a cardiac ablation procedure, take medication and also have an ICD. As a result, only few studies have directly compared these different approaches with each other individually. The most suitable approach will depend on a number of factors, such as the cause of the abnormal heartbeat or whether it makes you faint. Other factors include any other medical conditions you may have and your own preferences. A decision aid can help you learn more about the different preventive measures and find out which is the most suitable for your individual situation.

What does an ICD do?

Like pacemakers, implantable cardioverter-defibrillators (ICDs) are implanted in the chest area – under the skin or chest muscle – in a minor surgical procedure. The device is connected to the heart by thin wires (leads) that have electrodes at the end of them.

The ICD monitors the heartbeat. If it detects ventricular tachycardia, it sends one or several controlled electric shocks to the heart. This can quickly restore a normal heart rhythm and lower the risk of complications.

Illustration: An ICD sends out controlled electric shocks to return the heartbeat to normal

When is an ICD considered?

An ICD may be suitable for the following people, as long as they also take the necessary medication regularly (for example, ACE inhibitors) and are expected to live longer than one more year with a good quality of life:

  • People who have already had episodes of ventricular tachycardia or have been reanimated after sudden cardiac death – unless the underlying cause can be treated and eliminated.
  • People who have a higher risk of ventricular tachycardia with life-threatening complications due to another heart condition – even if they've never had ventricular tachycardia before. These are often people whose heart has not completely recovered from a . The risk of ventricular tachycardia and sudden cardiac death is considered to be higher if symptoms such as weakness or shortness of breath don't go away after a and the heart's ability to pump blood is still affected weeks later. The aim of implanting the ICD is to prevent these complications.
  • Those whose heart is weak for other reasons. People who have severe heart failure are often given an ICD as part of their cardiac resynchronization therapy (CRT). Then the role of the ICD is not only to act as a defibrillator when needed, but also to make sure that the chambers of the heart (the atria and ventricles) are pumping regularly and effectively.

An ICD can also help in people who are waiting for a heart transplant.

What are the benefits of an ICD?

Good-quality research has shown that an ICD helps to prevent sudden cardiac death in people who have a higher risk of ventricular tachycardia and related complications. According to the research, within two to three years

  • 8 out of 100 people who did not have an ICD died of sudden cardiac death, and
  • 3 out of 100 people who had an ICD died of sudden cardiac death.

ICDs can also record data – for example, on how well the heart is pumping blood or when they sent an electric shock. Some of these devices can also regularly send this information to a doctor's office or hospital (telemonitoring) so that necessary tests can be done or the treatment can be adjusted, for instance. These additional functions can prevent cardiovascular complications that are sometimes life-threatening. It is not clear whether they can increase life expectancy, though.

What are the risks of this treatment?

The main risks of treatment with an ICD are infections, bleeding, wound-healing problems and device malfunctions. If the ICD malfunctions, it may send bursts of electricity that aren't needed. Overall, about 3 out of 100 people with an ICD develop complications, and about 1 out of 100 develop complications that are severe or even life-threatening.

If you notice episodes of ventricular tachycardia, you will also feel the bursts of electricity sent by the ICD. That is often unpleasant or painful and can be frightening and distressing.

Although an ICD can stop ventricular tachycardia, it can't prevent it. To keep the number of episodes to a minimum, medication or cardiac ablation are used as well.

It is generally possible to switch an ICD off. This can be done without having another surgical procedure. Some people might decide to do that in the final stages of their life – for example, because their heart disease is so severe that the device would send electric shocks too often.

What happens during catheter ablation?

Catheter ablation (sometimes called cardiac ablation) involves "deactivating" the parts of the heart that are responsible for the ventricular tachycardia.

A doctor inserts a flexible tube called a into a blood vessel in the groin and then gently pushes it through to the heart. First, the is used to perform a procedure called an electrophysiology (EP) study. Targeted bursts of electricity are sent to trigger the abnormal heartbeat. That way, the doctor can see exactly which area of heart tissue is causing the ventricular tachycardia. Then the tissue there is ablated (destroyed) right away – typically by heating it with electricity until a scar forms. The ablation is usually done under brief, light anesthesia.

Who is this procedure considered for?

This procedure is especially recommended if

  • some of the heart tissue is scarred from a , and that is causing a lot of ventricular tachycardia episodes despite using medication – so the ICD often sends (or would often send) bursts of electricity,
  • treatment with medication is either not wanted or not possible (for instance, because the medication is not well tolerated),
  • the ventricular tachycardia is being caused by problems in the electrical pathways of the ventricles, a hereditary disorder affecting the electrical activity of the heart, or a congenital ("at birth") heart defect.

If the heart is otherwise healthy – in other words, you don't have coronary artery disease (CAD) or any other heart problems – and you still have ventricular tachycardia episodes, then experts recommend ablation rather than using medication over the long term. But this procedure can only be done if the area of the heart causing the ventricular tachycardia can be clearly defined and easily reached with a . People whose heart is otherwise not damaged do not need an ICD. Sometimes people who have persistent ventricular tachycardia due to CAD are advised to have cardiac ablation instead of an ICD. But only if their heart is able to beat strongly enough to keep their blood circulation stable despite the abnormal heartbeat.

How effective is cardiac ablation?

Researchers have looked into the effectiveness of cardiac ablation in preventing ventricular tachycardia and related complications. So far, most of the people in the studies already had an ICD because of coronary artery disease. That research suggests that – in these people and compared to medication – cardiac ablation is better at preventing further episodes of ventricular tachycardia, as well as the necessary but painful and distressing bursts of electricity from the ICD. But it's not clear whether ablation can increase life expectancy more than medication can.

What are the risks?

Catheter ablation leads to complications in about 4 to 11 out of 100 people whose heart is already damaged by coronary artery disease. These complications include injury to the heart or blood vessels, bleeding, heart rhythm problems, a heart attack and stroke. Up to 3 out of 100 people die during the procedure or shortly after. The risk of complications is much lower in people with an otherwise healthy heart, though.

Which medicines can prevent complications?

Beta blockers are often used. They have been shown to prevent life-threatening complications such as ventricular tachycardia in people with heart disease. Beta blockers are usually well tolerated. The possible side effects include a slow heartbeat, low blood pressure and breathing problems.

Sometimes special anti-arrhythmics are also used. But there's no good scientific proof that they prevent life-threatening complications. There is only some weak to suggest that the substance amiodarone could have a preventive effect.

Because a wide variety of anti-arrhythmic drugs are used to treat ventricular tachycardia, the possible side effects vary too. Many of the medicines can themselves cause an abnormal heartbeat. Other typical side effects include headaches, nausea and low blood pressure. Amiodarone can also affect the thyroid gland and lead to lung, liver or eye problems.

Additional medications are recommended for people with heart failure. They don't affect the heartbeat directly, but still help to prevent life-threatening complications such as ventricular fibrillation and sudden cardiac death. Blood-pressure-lowering drugs like ACE inhibitors can be used for this purpose.

Are there other options?

Sometimes ablation is not possible. Then the tissue causing the problem can be destroyed (ablated) by doing surgery on the heart instead. In rare cases, the tissue is destroyed using a special type of radiation therapy.

Other approaches aim to influence the autonomic nervous system in the heart: This system consists of calming (parasympathetic) and stimulating (sympathetic) parts. In some people at higher risk of ventricular tachycardia, it may be helpful to stimulate the parasympathetic nervous system or suppress the sympathetic nervous system. This can be done in very different ways. For example, the nerve fibers of the sympathetic nervous system can be blocked in a surgical procedure. Not enough is currently known about the benefits and risks of these approaches. Because of this, they are only used in rare cases – for example, if other measures haven't helped.

To avoid increasing the risk of heart problems even more, you can try to lead a healthy lifestyle – for instance, by not smoking and keeping your weight in check.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on November 28, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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