Abstract / Summary
Background/Objectives: Sustained ventricular tachycardia (VT) is a potentially life-threatening arrhythmia requiring prompt Emergency Department (ED) assessment and management. However, data on its frequency, real-world treatment, and prognosis in the ED remain limited. We aimed to describe the clinical characteristics, acute management, and short- and long-term outcomes of patients presenting with VT. Methods: We retrospectively included consecutive patients presenting to the ED between January 2018 and December 2024 with a primary diagnosis of sustained VT with a pulse. We collected baseline characteristics, hemodynamic status, underlying cardiac disease, and acute treatment. In-hospital events and 30-day and 1-year outcomes were assessed. Results: A total of 103 patients were identified, accounting for approximately 0.025% of all ED visits during the study period; 84.5% were male. Chest pain (31.1%) and palpitations (25.2%) were the most common presenting symptoms. Structural heart disease was present in 90% of the cases, predominantly of ischemic origin (61%). Nearly half of the patients (49.5%) had a prior history of VT. Electrical cardioversion was performed in 28.2% of the cases. The majority of the patients (95/103; 92%) required hospitalization. Mortality was 4.9% at 30 days and 17% at 1 year. After adjustment for age, a left ventricular ejection fraction ≤ 30% and in-hospital arrhythmic recurrence were independently associated with 1-year mortality. Conclusions: Sustained VT is an uncommon but high-risk ED presentation, mainly affecting patients with ischemic structural heart disease. A discrepancy was observed between real-world clinical practice and guideline recommendations. The substantial mortality observed, particularly among patients with impaired left ventricular function or in-hospital arrhythmic recurrence, highlights the need for prompt risk stratification and optimized, guideline-concordant acute management.