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Ventricular tachycardia
Wide-complex tachycardia; V tach; Tachycardia - ventricular Last reviewed: May 6, 2010. Ventricular tachycardia (VT) is a rapid heartbeat that starts in the ventricles.

Causes, incidence, and risk factors

Ventricular tachycardia is a pulse rate of more than 100 beats per minute, with at least three irregular heartbeats in a row. The condition can develop as an early or late complication of a heart attack. It may also occur in patients with:

Cardiomyopathy Heart failure Heart surgery Myocarditis Valvular heart disease

Ventricular tachycardia can occur without heart disease. Scar tissue may form in the muscle of the ventricles days, months, or years after a heart attack. This can lead to ventricular tachycardia. Ventricular tachycardia can also be caused by:

Anti-arrhythmic medications Changes in blood chemistry (such as a low potassium level) Changes in pH (acid-base) Lack of enough oxygen

"Torsade de pointes" is a form of ventricular tachycardia that is often due to congenital heart disease or the use of certain medications.

Symptoms
If the heart rate during a ventricular tachycardia episode is very fast or lasts longer than a few seconds. There may be symptoms such as:

Chest discomfort (angina) Fainting (syncope) Light-headedness or dizziness Sensation of feeling the heart beat (palpitations) Shortness of breath

Note: Symptoms may start and stop suddenly. In some cases, there are no symptoms.

Signs and tests

Signs include:

Absent pulse Loss of consciousness Normal or low blood pressure Rapid pulse

Ventricular tachycardia may be seen on:

Continuous ambulatory electrocardiogram (Holter monitor) ECG Intracardiac electrophysiology study (EPS) Loop recorder

Blood chemistries and other tests may be done.

Treatment
Treatment depends on the symptoms, and the type of heart disorder. Some people may not need treatment. If ventricular tachycardia becomes an emergency situation, it may require:

CPR Electrical defibrillation or cardioversion (electric shock)

Anti-arrhythmic medications (such as lidocaine, procainamide, sotalol, or amiodarone) given through a vein

Long-term treatment of ventricular tachycardia may require the use of oral anti-arrhythmic medications (such as procainamide, amiodarone, or sotalol). However, anti-arrhythmic medications may have severe side effects. Their use is decreasing in favor of other treatments. Some ventricular tachycardias may be treated with an ablation procedure. Radiofrequency catheter ablation can cure certain tachycardias. A preferred treatment for many chronic (long-term) ventricular tachycardias consists of implanting a device called implantable cardioverter defibrillator (ICD). The ICD is usually implanted in the chest, like a pacemaker. It is connected to the heart with wires. The doctor programs the ICD to sense when ventricular tachycardia is occurring, and to administer a shock to stop it. The ICD may also be programmed to send a rapid burst of paced beats to interrupt the ventricular tachycardia. You may need to take anti-arrhythmic drugs to prevent repeated firing of the ICD.

Expectations (prognosis)
The outcome depends on the heart condition and symptoms.

Complications
Ventricular tachycardia may not cause symptoms in some people. However, it may be lethal in other people. It is a major cause of sudden cardiac death.

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid, irregular pulse, faint, or have chest pain. All of these may be signs of ventricular tachycardia.

Prevention
In some cases, the disorder is not preventable. In other cases, it can be prevented by treating heart diseases and correcting blood chemistries.

References
1. Olgin JE, Zipes DP. Specific Arrhythmias: Diagnosis and Treatment. In: Libby P, Bonow RO, Mann DL, Zipes DP. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 35. 2. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA,HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm

Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC?AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 117:e350-e408. Review Date: 5/6/2010. Reviewed by: Issam Mikati, MD, Associate Professor of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Disclaimer Copyright 2012, A.D.A.M., Inc.

What works?

Intravenous magnesium for acute myocardial infarction Intravenous magnesium for acute myocardial infarction In some countries, intravenous (IV) magnesium is administered to heart attack patients in order to limit damage to the heart muscle, prevent serious arrhythmias and reduce the risk of death. Several small trials appeared to support the practice. But the authors of this review found that other trials went unpublished once they produced unfavorable results. A controversy erupted in 1995, when a large welldesigned trial with 58,050 participants did not demonstrate any beneficial effect to IV magnesium, contradicting earlier metaanalyses of the smaller trials. This review includes 26 clinical trials that had randomly assigned heart attack patients to receive either IV magnesium or an inactive substance (placebo). Their results were mixed: IV magnesium reduced the incidence of serious arrhythmias, but this treatment also increased the incidence of profound hypotension, bradycardia and flushing. However, any apparent beneficial effects of magnesium may simply reflect various biases in these trials. Additionally, there was a lack of uniformity in these trials in terms of dosage and the timing of the IV magnesium regimen, which in some trials also included anticlotting drugs. The evidence produced by this review does not support continued use of IV magnesium. Other effective treatments (aspirin, betablockers) should be used to treat heart attack.

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Drugs of interest

Amiodarone Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.

Sotalol Sotalol is used to treat irregular heartbeats. Sotalol is in a class of medications called antiarrhythmics. It works by acting on the heart muscle to improve the heart's rhythm.

Procainamide Oral Procainamide is used to treat abnormal heart rhythms. It works by making your heart more resistant to abnormal activity.

Verapamil Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calciumchannel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate.

Dronedarone Dronedarone is used to treat people who have had atrial fibrillation (a heart rhythm disorder that may cause the heartbeat to be fast and irregular) or atrial flutter (a heart rhythm disorder that may cause the heartbeat to be fast but regular) during the past 6 months and who also have certain other conditions that increase the risk that they will develop heart problems. Dronedarone decreases the risk that people who have these conditions will need to be hospitalized to treat heart problems. Dronedarone is in a class of medications called antiarrhythmics. It works by helping the heart to beat normally.

Read More

Heart palpitations Heart attack Cardiomyopathy Mitral valve prolapse Myocarditis Comprehensive metabolic panel Stimulus Cardiac ablation procedures Implantable cardioverter-defibrillator

Arrhythmia

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