Edit concept Question Editor Create issue ticket

Paroxysmal Ventricular Tachycardia

Paroxysmal ventricular tachycardia is a rhythm abnormality characterized by a series of ventricular contractions originating from one or more ventricular loci, at a rate greater than 100-120 beats/minute. The tachycardia is considered to be nonsustained if it lasts for less than 30 seconds, or sustained if the duration is longer.


Presentation

The typical presentation of ventricular tachycardia (VT) is represented by palpitations. If there is cardiovascular compromise then symptoms are much more severe and consist of vertigo, syncope, chest pain, dyspnea due to decreased cerebral and myocardial irrigation or venous pulmonary hypertension. The term "paroxysmal" entails that the beginning and the end of the episode occur abruptly.

Patients with personal or familial history of sudden death should be evaluated for long and short QT syndromes, Brugada syndrome, arrhythmogenic right ventricular dysplasia and catecholaminergic polymorphic VT [1] [2], as family history of these diseases may indicate that the condition is present in the examined patient [3] [4].

If there is a loss of consciousness in the supine position or the patient has no aura, then the patient should be evaluated for VT, as vasovagal syncope usually appears in other contexts [5]. It is also important to determine what medication the patient is taking since certain drugs are known to have proarrhythmic effects.

Tachycardia
  • Successful drug response (prevention of ventricular tachycardia induction or induction of nonsustained episodes of tachycardia) was noted in six of nine patients (66 percent).[ncbi.nlm.nih.gov]
  • Rapid ventricular pacing, at a rate of up to 50 beats/min faster than the tachycardia rate terminated 7 of the tachycardias.[ncbi.nlm.nih.gov]
  • Ventricular fibrillation occurred in six cases of paroxysmal ventricular tachycardia due to early ventricular premature contractions but was absent in paroxysmal ventricular tachycardia related to late ventricular or atrial premature contractions.[ncbi.nlm.nih.gov]
  • The tachycardia is considered to be nonsustained if it lasts for less than 30 seconds, or sustained if the duration is longer. The typical presentation of ventricular tachycardia (VT) is represented by palpitations.[symptoma.com]
  • We wish to draw attention to the common neurological symptoms with which paroxysmal ventricular tachycardia may present.[ncbi.nlm.nih.gov]
Heart Disease
  • She had severe hyperemesis, palpitation at 6 weeks of gestation and many episodes of paroxysmal VT, but no apparent organic heart disease. At that time she had a transient increase of thyroid hormone levels.[ncbi.nlm.nih.gov]
  • In contrast to the ominous prognosis of paroxysmal ventricular tachycardia associated with organic heart disease, 15, 20 this arrythmia, occurring without underlying heart disease, is generally a benign disorder and the prognosis is good. 12, 20 The patients[annals.org]
  • There was no evidence of organic heart disease. In one of the patients the symptoms usually developed when standing after working in a crouched position. He responded to treatment with beta-adrenergic blockade.[ncbi.nlm.nih.gov]
  • It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including an increase in atrial fibrillation rate.[ncbi.nlm.nih.gov]
  • Complete recovery without lasting adverse reactions may be expected if there is no serious underlying heart disease.[nmihi.com]
Ventricular Bigeminy
  • RVOT non-sustained monomorphic ventricular tachycardia (on the left side) and LVOT ventricular bigeminy (on the right side). Figure 2. Fascicular VT with RBBB morphology and left anterior fascicular block pattern.[escardio.org]

Workup

Physical examination findings depend on whether the evaluation is performed during the crisis or between episodes. During the interval between episodes, patients may show signs of structural heart conditions such as murmurs or other pathological features of decompensated heart disease. During the VT episode, patients are tachycardic, possibly tachypneic and may either be anxious, lethargic or comatose, depending on the cerebral perfusion and blood pressure. Diminished peripheral perfusion manifests as pallor and diaphoresis.

The main tool that establishes the diagnosis of ventricular tachycardia is electrocardiography. The arrhythmia may be monomorphic or polymorphic, depending on the number of hyperexcitable loci, commonly located in the ventricular outflow tracts, aortic root or left ventricular septum [6]. When VT occurs in a patient with long QT syndrome, this entity is called "torsade de pointes" and has a particular morphology. Reentrant tachycardia has a structural substrate, most commonly consisting of scar tissue and in this case, an electrophysiological study offers relevant information. QRS complex aspect depends on the origin site of the tachycardia [7] [8].

The distinction between monomorphic VT and supraventricular tachycardia with aberrant conduction is made using Brugada [9] and Verekei [10] criteria, like atrioventricular dissociation, captures and fusion beats or a negative QRS complex in aVR during abnormal conduction of SVT. Signal-averaged ECG is also useful in differentiating between the two entities [11].

Blood workup in VT patients should include potassium, magnesium, calcium levels, toxicology screening, digoxin, troponin I or T levels. Echocardiography should be performed, as it may find the structural etiology of the arrhythmia like right ventricular or global cardiomyopathies or post-ischemic scars. Genetic testing for Brugada and long QT syndromes and catecholaminergic polymorphic VT is also useful.

Wide QRS Complex
  • QRS complex This feature of pre-excitation can not be observed during tachycardia or in a patient with "concealed pathway" (retrograde conduction) Commonly found on ECG in WPW Not visible during tachycardia or in patients with a concealed pathway (retrograde[amboss.com]
  • Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide qrs complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (av dissociation).[icd10data.com]
  • Wide QRS complexes ( 120 ms). Presence of AV dissociation. Fusion beats. Retrograde ventriculoatrial conduction may occur, which can generate an ECG complex similar to PSVT with aberrant conduction.[patient.info]
  • A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 1991;83:1649-59. 16.- Ohe T, Aihara N, Kamakura S, et al.[escardio.org]
Ventricular Bigeminy
  • RVOT non-sustained monomorphic ventricular tachycardia (on the left side) and LVOT ventricular bigeminy (on the right side). Figure 2. Fascicular VT with RBBB morphology and left anterior fascicular block pattern.[escardio.org]
Atrioventricular Dissociation
  • The distinction between monomorphic VT and supraventricular tachycardia with aberrant conduction is made using Brugada and Verekei criteria, like atrioventricular dissociation, captures and fusion beats or a negative QRS complex in aVR during abnormal[symptoma.com]
Inverted P Wave
  • Permanent junctional reciprocating tachycardia ( PJRT ) The electric impulse is conducted in a retrograde fashion from the ventricles to the atria by a concealed accessory pathway orthodromic AVRT ECG : similar to orthodromic AVRT but with inverted P[amboss.com]

Treatment

  • The clinical course of two otherwise healthy pregnant patients with this arrhythmia in whom treatment was withheld is outlined. The indications and guidelines for treatment in relatively asymptomatic patients is discussed.[ncbi.nlm.nih.gov]
  • Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.[drugs.com]
  • Abstract Both antiarrhythmic drugs and bursts of rapid ventricular pacing provide alternatives to DC cardioversion for the treatment of paroxysmal ventricular tachycardia.[ncbi.nlm.nih.gov]
  • […] when treatment is started early in pregnancy.[jpgo.org]
  • He responded to treatment with beta-adrenergic blockade. The other patient developed her symptoms on standing, after exercise or other stress.[ncbi.nlm.nih.gov]

Prognosis

  • Significant ventricular arrhythmia in the patient after infarction is said to carry a poor prognosis with regard to survival.[ncbi.nlm.nih.gov]
  • In contrast to the ominous prognosis of paroxysmal ventricular tachycardia associated with organic heart disease, 15, 20 this arrythmia, occurring without underlying heart disease, is generally a benign disorder and the prognosis is good. 12, 20 The patients[annals.org]
  • The arrhythmia in this patient was not associated with any other evidence of heart disease and apparently does not have an unfavorable prognosis. The etiology and therapy of this condition are briefly discussed. Received March 24, 1958.[pediatrics.aappublications.org]
  • […] occasion may be used in children with PSVT who have not responded to any other treatment) Surgery to change the pathways in the heart that send electrical signals (this may be recommended in some cases for people who need other heart surgery) Outlook (Prognosis[mountsinai.org]
  • Predicted outcome Prognosis depends on the type and degree of underlying heart disease. The outcome is good for individuals who experience ventricular tachycardia as a one-time experience.[nmihi.com]

Etiology

  • Echocardiography should be performed, as it may find the structural etiology of the arrhythmia like right ventricular or global cardiomyopathies or post-ischemic scars.[symptoma.com]
  • The etiology and therapy of this condition are briefly discussed. Received March 24, 1958. Accepted April 21, 1958.[pediatrics.aappublications.org]
  • […] rheumatic heart disease, pericarditis, pneumonia, chronic lung disease, current alcohol intoxication,Digoxin toxicity (medscape) most common SVT. accelerated sinus rate that is a physiologic response to a stressor. regular rhythm, HR 100 sinus tachycardia etiologies[quizlet.com]
  • Background: The aim of this case report is to underline the possible etiological link between paroxysmal supraventricular tachycardia (PSVT) and hypothyroidism, although supraventricular arrhythmias are ordinary features of hyperthyroidism.[endocrine-abstracts.org]
  • Etiology Atrioventricular nodal reentrant tachycardia ( AVNRT ) : tachycardia caused by a dysfunctional AV node that contains two electrical pathways Atrioventricular reciprocating tachycardia ( AVRT ) : tachycardia caused by an accessory pathway between[amboss.com]

Epidemiology

  • Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Summary Epidemiology The prevalence of CPVT in Europe is 1/10,000. Clinical description Typical age of onset of CPVT is between 7 and 9 years of age with no sex difference.[orpha.net]
  • Epidemiology VT is a fairly frequently observed dysrhythmia but actual incidence is difficult to quantify because of the overlap with VF.[patient.info]
  • Top Your questions, contributions and commentaries will be answered by the lecturer or experts on the subject in the Prevention and Epidemiology list. Please fill in the form (in Spanish, Portuguese or English) and press the "Send" button.[fac.org.ar]
Sex distribution
Age distribution

Pathophysiology

  • […] impulse is conducted in a retrograde fashion from the ventricles to the atria by a concealed accessory pathway orthodromic AVRT ECG : similar to orthodromic AVRT but with inverted P waves in leads II, III, aVF, V 3 -V 6 Rare: References: [1] [3] [4] Pathophysiology[amboss.com]
  • Pathophysiology The AV node in these patients behaves functionally as if there were two separate pathways through the node. The two pathways (alfa and beta pathways ) are differentiated by their characteristic electophysiologic pr operties.[af-ablation.org]

Prevention

  • Nine patients with recurrent paroxysmal ventricular tachycardia underwent chronic electrophysiologic studies to delineate effective drug therapy for prevention of recurrence of this arrhythmia.[ncbi.nlm.nih.gov]
  • The use of both techniques allowed the extinction of all 11 tachycardias and prevented the need to proceed to DC conversion.[ncbi.nlm.nih.gov]
  • Drugs such as beta-blockers, digoxin or ones to prevent arrhythmias may be used to help prevent future episodes. More and more often, radiofrequency ablation is done to destroy the tissues where paroxysmal supraventricular tachycardia starts.[cedars-sinai.edu]
  • In many cases, an initial episode of VT cannot be prevented. However, once diagnosed, treatment can help prevent future episodes.[nmihi.com]
  • If abnormal tracts or short circuits are found, they can be ablated or destroyed with high frequency radio waves and hopefully, prevent future episodes of PSVT.[rxlist.com]

References

Article

  1. Wolpert C, Schimpf R, Veltmann C, Giustetto C, et al. Clinical characteristics and treatment of short QT syndrome. Expert Rev Cardiovasc Ther. 2005;3(4):611-7.
  2. Patel U, Pavri BB. Short QT syndrome: a review. Cardiol Rev. 2009;17(6):300-3.
  3. Jouven X, Desnos M, Guerot C, Ducimetiere P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation 1999;99:1978–1983.
  4. Friedlander Y, Siscovick DS, Weinmann S, et al. Family history as a risk factor for primary cardiac arrest. Circulation 1998;97:155–160.
  5. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope. Eur Heart J 2009;30:2631–2671.
  6. Arya A, Piorkowski C, Sommer P, et al. Idiopathic outflow tract tachycardias: current perspectives. Herz. 2007;32(3):218-25.
  7. Josephson ME, Callans DJ. Using the twelve-lead electrocardiogram to localize the site of origin of ventricular tachycardia. Heart Rhythm. 2005;2(4):443-6.
  8. Noda T, Shimizu W, Taguchi A, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol. 2005; 46(7):1288-94.
  9. Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83(5):1649-59.
  10. Vereckei A, Duray G, Szénási Get al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5(1):89-98.
  11. [Guideline] Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. 2006; 48(5):e247-346.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-06-28 09:29