Long-term management of ventricular tachyarrhythmias
Beta-blocking agents or verapamil are recommended for the prevention of idiopathic sustained VT if associated with severe symptoms or hemodynamic compromise . If they fail, sotalol or flecainide may be used instead. In those with long QT syndrome or catecholaminergic polymorphic VT beta-blocking agents are essential during pregnancy and post-partum.
Implantable cardioverter-defibrillator (ICD), preferably single chamber, is recommended prior to pregnancy when clinically indicated. If an indication emerges during pregnancy, subcutaneous ICD implantation is advised since its implant does not demand fluoroscopy. When, for any given reason, an endocardial implant is chosen, echocardiographic and/or electroanatomical mapping guidance is recommended, especially if the fetus is in the first trimester of gestation. Catheter ablation with electroanatomical mapping systems may be considered in experienced centers for sustained drug-refractory and poorly tolerated VT if there are no other alternatives.