Ventricular Tachycardia (VT): A Detailed Explanation

Introduction

Sustained Ventricular Tachycardia (VT) is a type of abnormal heart rhythm that originates in the ventricles (the lower chambers of the heart) and lasts for more than 30 seconds or requires medical intervention due to hemodynamic instability. It is a potentially life-threatening arrhythmia that can lead to cardiac arrest if not properly managed.

Causes and Risk Factors

Sustained VT can develop due to various underlying conditions, including: - Coronary artery disease (CAD) – A common cause, especially after a heart attack (myocardial infarction). - Cardiomyopathy – Structural heart diseases such as dilated or hypertrophic cardiomyopathy increase the risk. - Electrolyte imbalances – Low potassium or magnesium levels can trigger VT. - Congenital heart diseases – Some inherited conditions, such as Long QT syndrome or Brugada syndrome. - Drug-induced VT – Certain medications, particularly those that prolong the QT interval.

Symptoms

Symptoms of sustained VT can range from mild to life-threatening and include: - Palpitations (rapid or irregular heartbeat) - Dizziness or lightheadedness - Shortness of breath - Chest pain - Syncope (fainting) - Sudden cardiac arrest in severe cases

Diagnosis

A doctor may use one or more of the following methods to confirm a diagnosis of VT: - Electrocardiogram (ECG) – The primary tool to detect VT. - Holter monitoring – A 24-hour ECG monitoring to capture intermittent VT episodes. - Echocardiogram – To assess heart function and structure. - Cardiac MRI or CT – Used in detecting underlying heart disease. - Electrophysiological (EP) study – Helps to determine the exact location of the arrhythmia.

Treatment Options

Immediate Treatment:

• Electrical cardioversion/defibrillation – If the patient is unstable, immediate synchronized cardioversion or defibrillation is needed.
• Antiarrhythmic drugs – Intravenous medications such as amiodarone or lidocaine are commonly used in emergency settings.

Long-Term Management:

• Implantable Cardioverter-Defibrillator (ICD) – Recommended for patients at high risk of sudden cardiac death.
• Catheter Ablation – A procedure used to destroy abnormal electrical pathways.
• Medications – Beta-blockers, antiarrhythmics (e.g., sotalol, amiodarone) are commonly prescribed.
• Lifestyle modifications – Regular exercise, avoiding stimulant substances (caffeine, alcohol), and managing stress can help prevent recurrent episodes.

Prognosis

The outlook depends on the underlying cause, response to therapy, and comorbid conditions. Early detection and appropriate treatment significantly improve survival and quality of life.

Conclusion

Sustained VT requires prompt medical attention. If you or someone you know experiences symptoms like rapid heartbeat, fainting, or chest pain, seek emergency care. Long-term management by a cardiologist is essential for reducing risks and improving outcomes.

Source recommendations

1. American Heart Association (AHA) Guidelines on Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
2. https://pubmed.ncbi.nlm.nih.gov/29097320/
3. https://www.sciencedirect.com/science/article/pii/S2405500X22010945
4. https://pubmed.ncbi.nlm.nih.gov/29084733/
5. https://www.hrsonline.org/guidance/clinical-resources/2017-ahaacchrs-guideline-management-patients-ventricular-arrhythmias-and-prevention-sudden-cardiac

2. European Society of Cardiology (ESC) Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

1. https://pubmed.ncbi.nlm.nih.gov/36017572/
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
3. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
4. https://pubmed.ncbi.nlm.nih.gov/26320108/
5. https://academic.oup.com/eurheartj/article/36/41/2793/2293363