VT in Heart Failure — RACP Adult Medicine MCQ

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ModerateCardiologyVT in Heart FailureRACP Adult Medicine

A 65-year-old man with ischaemic heart disease and HFrEF (LVEF 30%) is on optimal quadruple therapy (sacubitril/valsartan, carvedilol, spironolactone, dapagliflozin). He presents with recurrent episodes of sustained ventricular tachycardia. He has previously declined ICD. What antiarrhythmic agent is appropriate?

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Correct answer: B — Amiodarone

In patients with structural heart disease and HFrEF, amiodarone is the only antiarrhythmic that can be used safely for VT. Flecainide and other class IC agents are contraindicated in structural heart disease (CAST trial). Sotalol is relatively contraindicated in severe HFrEF due to negative inotropy. Dronedarone is contraindicated in NYHA class III–IV HF. Verapamil is contraindicated in HFrEF. Amiodarone has minimal negative inotropic effect but requires monitoring for thyroid, pulmonary, and hepatic toxicity.

Reference: eTG – 2025 – Cardiovascular; ESC – 2022 – Ventricular Arrhythmia Guidelines