Understanding Ventricular Tachycardia (V-Tach) on ECG

Introduction

Ventricular Tachycardia (V-Tach) is a life-threatening arrhythmia that originates in the ventricles. It appears as a wide-QRS complex tachycardia on an electrocardiogram (ECG) and requires prompt medical evaluation.

Key ECG Features

• Wide QRS Complex (>120 ms or >3 small squares on ECG paper)
• Regular rhythm unless polymorphic VT
• Heart rate usually between 100–250 bpm
• No visible P waves or dissociated P waves

Types of V-Tach

1. Monomorphic VT – All QRS complexes look similar and have regular rhythm.
2. Polymorphic VT – QRS complexes vary in shape and amplitude.
3. Torsades de Pointes – A specific type of polymorphic VT often linked to QT prolongation.

Causes of V-Tach

• Coronary artery disease (e.g., previous myocardial infarction)
• Structural heart diseases (e.g., cardiomyopathy)
• Electrolyte imbalances (e.g., low potassium, magnesium)
• Drug toxicity (e.g., antiarrhythmics, tricyclic antidepressants)
• Congenital conditions (e.g., long QT syndrome, Brugada syndrome)

Management Approach

1. Immediate Assessment
   • Check for hemodynamic stability.
   • If unstable (e.g., hypotension, altered mental status) → Immediate cardioversion.
   • If stable → Consider antiarrhythmic medications.
2. Medications
   • Amiodarone (preferred for stable and unstable VT)
   • Lidocaine or Procainamide in some cases
3. Long-Term Management
   • Implantable Cardioverter Defibrillator (ICD) for high-risk patients
   • Medications like beta-blockers in select cases
   • Catheter ablation if VT is recurrent

Conclusion

Ventricular Tachycardia is a dangerous cardiac arrhythmia that requires quick identification and treatment. ECG interpretation skills are essential for early detection, and both acute and long-term management strategies should be personalized based on the patient’s underlying condition.

Source recommendations

1. American Heart Association Guidelines on Ventricular Arrhythmias and Sudden Cardiac Death

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
2. https://pubmed.ncbi.nlm.nih.gov/16949478/
3. https://www.sciencedirect.com/science/article/pii/S2405500X22010945
4. https://pubmed.ncbi.nlm.nih.gov/29097320/
5. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/ventricular-fibrillation

2. European Society of Cardiology Guidelines on Ventricular Arrhythmias

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.sciencedirect.com/science/article/pii/S2405500X22010945