Ventricular Tachycardia (VT)

Introduction

Ventricular tachycardia (VT) is a life-threatening arrhythmia that originates in the ventricles and is typically characterized by a rapid heart rate (>100 beats per minute). It can be classified into sustained and non-sustained forms, and it requires prompt evaluation and management.

Causes of VT

Structural Heart Disease:

  • Coronary artery disease (CAD): Often associated with myocardial infarction and scarring.
  • Cardiomyopathy: Conditions such as dilated or hypertrophic cardiomyopathy.
  • Congenital heart disease: Some congenital defects predispose to VT.

Non-Structural Causes:

  • Electrolyte imbalances (e.g., low potassium or magnesium).
  • Drug-induced VT: Medications like antiarrhythmics, digitalis toxicity.
  • Genetic syndromes: Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic VT.

Symptoms of VT

  • Palpitations
  • Dizziness
  • Syncope (fainting)
  • Chest pain
  • Sudden cardiac arrest in severe cases

Diagnosis of VT

  1. Electrocardiogram (ECG): Wide-complex tachycardia, characteristic morphology.
  2. Holter Monitoring: Continuous ECG recording for arrhythmia detection.
  3. Electrophysiology Study (EPS): Evaluates the source and mechanism of VT.
  4. Echocardiography/MRI: Assesses structural heart disease.

Treatment Options

Acute Management:

  • Stable VT: Antiarrhythmic drugs (amiodarone, procainamide, lidocaine).
  • Unstable VT: Immediate cardioversion.
  • Pulseless VT: Follow Advanced Cardiac Life Support (ACLS) protocol with defibrillation.

Long-term Management:

  • Implantable Cardioverter Defibrillator (ICD): Life-saving in many cases.
  • Medications: Beta-blockers, antiarrhythmics.
  • Catheter Ablation: For recurrent VT cases.
  • Lifestyle Changes: Control of underlying diseases (e.g., CAD management).

Conclusion

VT is a serious cardiac rhythm disorder requiring immediate attention and often long-term management. Early diagnosis and the right therapeutic approach significantly improve outcomes.

Source recommendations

1. 2022 AHA/ACC/HRS Guideline for the Management of Patients With 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://pubmed.ncbi.nlm.nih.gov/36017572/
  4. https://www.heartrhythmjournal.com/article/S1547-5271(17)31249-3/fulltext
  5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000548

2. 2022 ESC Guidelines on 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://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022
  5. https://academic.oup.com/europace/article/25/5/euad091/7143805

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