Primary prevention
Primary prevention is best accomplished by addressing risk factors for conditions that predispose to NSVT such as coronary artery disease and depressed left ventricular systolic dysfunction. Hypertension and hyperlipidaemia should be managed aggressively and smoking cessation should be strongly pursued. Regular physical activity may reduce the risk of ventricular arrhythmias by 11% to 22%.[30] Additional preventive measures include treatment of systolic dysfunction with medications such as ACE inhibitors/angiotensin receptor blockers, beta-blockers, and aldosterone antagonists.
Patients with diagnosed hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, Brugada's syndrome, and long QT syndrome should avoid strenuous physical exertion, as exercise can provoke NSVT (or other arrhythmias) in these populations.
A prophylactic implantable cardioverter defibrillator (ICD) should be considered for patients at risk for sudden cardiac death due to sustained ventricular arrhythmias. Although the presence of NSVT may be a useful risk factor for estimating risk in certain conditions, generally the decision on whether an ICD is implanted is based on multiple considerations such as age, family history, the presence of symptoms such as syncope, and the extent of structural heart disease present.
Secondary prevention
Patient compliance with medications prescribed for treatment of the underlying cardiac disease is essential. Factors that may trigger episodes of arrhythmia should also be avoided (e.g., mental or physical stress, or electrolyte imbalance). It is useful to note that caffeine has not been demonstrated to alter the inducibility or severity of ventricular arrhythmias.[72]
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