Unless contraindicated, -blockers should be tested in all patients for whom treatment is necessary. Next, in descending order of preference, are mexiletine and disopyramide. Tocainide, quinidine, procainamide, and amiodarone have significant long-term toxicity and are usually inappropriate. Flecainide is highly effective for VEB suppression, but it has been shown to worsen survival in post-MI survivors in whom VEBs are usually asymptomatic. Its place in those with symptomatic VEBs is under assessment.
Idioventricular rhythm is considered benign.
Unless producing hemodynamic upset, it usually is not treated. It occurs in patients who spontaneously undergo reperfusion or after thrombolytic therapy, a situation in which little is known of its implications and possible need for treatment. Brief salvos of unsustained VT are common in acute MI but have no immediate or late prognostic significance and should not be treated if asymptomatic. The association of VT with structural and usually severe underlying heart disease explains the prognostic seriousness. Treatment Immediate treatment of hypotensive VT requires synchronized DC shock.