Non-Ischaemic Polymorphic Ventricular Tachycardia Case Report: Treatment Shift to Cardiac Ablation

INTRODUCTION: Long-term management of ischaemic polymorphic ventricular tachycardia (pVT) has traditionally relied on beta-blockers as first-line therapy, with cardiac ablation reserved as the alternative option. In non-ischaemic cases, ablation was historically less recommended due to higher procedural risk and lower success rates. Emerging evidence, however, suggests a shift toward cardiac ablation as a gold-standard treatment for both ischaemic and non-ischaemic pVT. This case describes a 41-year-old man presenting with a two-month history of exertional palpitations consistent with non-ischaemic right ventricular outflow tract (RVOT) tachycardia and the decision to pursue cardiac ablation. METHODS: Patient provided consent for the case to be used. RESULTS: The patient was commenced on bisoprolol as interim medical therapy and scheduled for cardiac ablation for long-term management. DISCUSSION: This report reviews historical treatment strategies for ischaemic and non-ischaemic pVT and examines the evolving role of cardiac ablation as first-line therapy in non-ischaemic cases. CONCLUSION: Cardiac ablation was previously reserved for patients with recurrent pVT refractory to anti-arrhythmic drug therapy and for those who demonstrated limited pharmaceutical success in non-ischaemic cases. Advances in electrophysiological mapping and ablation techniques have improved cardiac ablation practices, posing it as a potential primary treatment for both ischaemic and non-ischaemic pVT. However, this shift in treatment management will depend on the results of ongoing trials such as PAUSE-SCD, IMPRESS, and LESS-VT.