Ventricular Tachycardia (VT)

Introduction

Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia that originates in the ventricles of the heart. It is characterized by a fast heart rate (usually over 100 bpm) and can lead to serious complications such as syncope (fainting), hemodynamic instability, and cardiac arrest.

Causes of VT

VT can occur in various conditions, including:

• Coronary artery disease (CAD) – Especially in patients with a history of myocardial infarction.
• Structural heart disease – Such as cardiomyopathy, heart failure, or inherited disorders.
• Electrolyte imbalances – Low levels of potassium or magnesium can increase the risk.
• Drug toxicity – Certain medications, including antiarrhythmics and stimulants, may trigger VT.
• Genetic syndromes – Long QT syndrome, Brugada syndrome, and other inherited conditions.

Symptoms of VT

Symptoms may vary depending on the duration and severity of VT, but common signs include:

• Palpitations (rapid or irregular heartbeat)
• Dizziness or lightheadedness
• Shortness of breath
• Chest pain
• Loss of consciousness (syncope with prolonged episodes)

Diagnosis of VT

Diagnostic tools include:

• Electrocardiogram (ECG) – The primary tool for detecting VT.
• Holter monitor – A wearable ECG that records heart rhythms over time.
• Echocardiogram – Evaluates structural heart diseases.
• Cardiac MRI – Provides detailed imaging to assess myocardial scarring.
• Electrophysiology study (EPS) – A specialized test to map the heart’s electrical activity.

Treatment of VT

Management depends on whether VT is stable or unstable.

Acute Management

• Stable VT (patient conscious, no severe symptoms):
  • Antiarrhythmic medications (e.g., amiodarone, lidocaine)
  • Beta-blockers if appropriate
  • Electrolyte corrections (potassium, magnesium)
• Unstable VT (loss of consciousness, shock, chest pain, hypotension):
  • Immediate synchronized cardioversion
  • Advanced cardiac life support (ACLS) if necessary

Long-term Management

• Implantable Cardioverter-Defibrillator (ICD) – Recommended for patients at high risk of sudden cardiac death.
• Catheter ablation – For drug-resistant VT or recurrent episodes.
• Medications – Beta-blockers, antiarrhythmics, and ACE inhibitors may reduce future risk.
• Lifestyle modifications – Managing underlying conditions, avoiding stimulants, and maintaining electrolyte balance.

Prevention and Prognosis

Early diagnosis and effective treatment can improve outcomes significantly. Patients with VT should have regular follow-ups with a cardiologist and adhere to treatment plans to reduce the likelihood of recurrence.

Conclusion

Ventricular tachycardia is a serious heart rhythm disorder requiring prompt recognition and management. With appropriate treatment, many patients with VT can achieve a good quality of life.

Source recommendations

1. American Heart Association Guidelines for Management of Arrhythmias

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
2. https://www.heart.org/en/health-topics/arrhythmia
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
4. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia
5. https://pubmed.ncbi.nlm.nih.gov/16949478/

2. European Society of Cardiology Guidelines on Ventricular Arrhythmias & Sudden Cardiac Death

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
4. https://pubmed.ncbi.nlm.nih.gov/36017572/
5. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022