Right Ventricular Outflow Tract Ventricular Tachycardia (RVOT-VT)

Introduction

Right Ventricular Outflow Tract Ventricular Tachycardia (RVOT-VT) is a type of idiopathic ventricular tachycardia (VT) that arises from the outflow region of the right ventricle. It is often seen in people with structurally normal hearts and represents the most common form of idiopathic VT.

Causes and Risk Factors

• Idiopathic origin: This means that the VT occurs without any underlying structural heart disease.
• Triggered activity: RVOT-VT is thought to be caused by calcium-dependent afterdepolarizations.
• Association with exercise and stress: It often occurs in response to physical activity or emotional stress.
• Genetic predisposition: Some cases may be linked to inherited conditions, though this is rare.

Symptoms

• Palpitations
• Dizziness or lightheadedness
• Syncope (fainting)
• Chest discomfort
• Fatigue (in rare cases)

Diagnosis

RVOT-VT is typically diagnosed using: - Electrocardiogram (ECG): Shows a characteristic morphology (left bundle branch block pattern with inferior axis). - Holter monitoring: Helps detect intermittent episodes. - Exercise stress test: Since RVOT-VT is often triggered by exertion, this can be helpful. - Cardiac MRI or Echocardiography: To rule out structural abnormalities. - Electrophysiological study (EPS): Can help localize the arrhythmia site and determine the best treatment approach.

Treatment

1. Lifestyle Modifications: Avoid known triggers like caffeine, stress, and excessive exercise if they provoke tachycardia episodes.
2. Medications:
   • Beta-blockers (e.g., metoprolol)
   • Calcium channel blockers (e.g., verapamil)
   • Antiarrhythmic drugs (if needed)
3. Catheter Ablation:
   • A highly effective treatment using radiofrequency energy to eliminate the arrhythmic focus.
   • Success rates exceed 80-90%.
4. Implantable Cardioverter Defibrillator (ICD): Rarely needed, unless there is a high risk of life-threatening arrhythmia.

Prognosis

• RVOT-VT is usually benign and does not lead to sudden cardiac death unless associated with structural heart disease.
• Many patients achieve full symptom control with medications or catheter ablation.

Conclusion

RVOT-VT is a manageable arrhythmia with a good prognosis when properly diagnosed and treated. If you experience symptoms such as frequent palpitations, consult a cardiologist for evaluation.

Source recommendations

1. 2022 AHA/ACC/HRS Guideline for the Management of Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

1. https://pubmed.ncbi.nlm.nih.gov/29084733/
2. https://www.sciencedirect.com/science/article/pii/S2405500X22010945
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000548
4. https://www.heartrhythmjournal.com/article/S1547-5271(17)31249-3/fulltext
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death

2. 2022 ESC Guidelines on Ventricular Arrhythmias and Sudden Cardiac Death

1. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
3. https://pubmed.ncbi.nlm.nih.gov/36017572/
4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022
5. https://pubmed.ncbi.nlm.nih.gov/26320108/