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Home | Articles | Cardiac | Ventricular Tachycardia

Ventricular Tachycardia

Last updated 3rd December 2020

Last updated on 26th July 2013 by Calum Murray

Diagnosis & Differential Diagnosis

  1. Classic cause of broad complex tachycardia.
  2. Differential is SVT with bundle branch block or accessory pathway.
  3. ECG diagnostic for VT if AV dissociation present as evidence by fusion or capture beats – shown below

More Likely To Be VT If

  1. History of heart disease
  2. Gross LAD with upright aVR/axis different from sinus rhythm
  3. QRS duration > 140 ms
  4. RBBB with Rsr (initial R wave > secondary R wave)
  5. Concordant complexes in chest leads (all positive or all negative) 

If In Doubt

  1. Assume VT
  2. Do not give Verapamil
  3. Can try Adenosine (unless asthmatic); carotid massage; intra-atrial ECG
  4. NB Patients with VT don’t always look unwell

Immediate Assessment and Management

  1. Initial bloods should include potassium, calcium and magnesium.
  2. If patient compromised due either to VT or SVT with BBB, then cardioversion is treatment of choice.

Pulseless VT (Cardiac Arrest)

  1. As per guidelines of European Resuscitation Council Click to View ERC Guidelines Online

VT With Hypotension Or Heart Failure

  1. Call anaesthetist with view to synchronised DC shock under GA
  2. In unlikely event that anaesthetist unavailable can cardiovert with IV Midazolam 5-10 mg

Options For Stable VT

  1. Amiodarone 300mg IV over 30mins then 900mg over 24 hours
  2. Amiodarone should be given by central line (or PIC line) whenever possible. It should never be given into a small vein on the back of the hand. A large antecubital vein is permissable for the first 300mg in an emergency.
  3. Magnesium 8mmol IV over 15min, then 50mmol over 24hrs by infusion.
  4. Overdrive ventricular pacing.
  5. DC cardioversion.
  6. Lignocaine is nowadays considered unfashionable but 100mg IV often cardioverts VT and is an acceptable alternative or addition to amiodarone in a stable patient.

Torsade De Pointes

  1. This means “twisting of the points”. It is typified by an irregular rate with varying QRS amplitude such that the complex appears to twist around the baseline.
  2. It is not usually sustained but will recur if the underlying cause is not corrected and may degenerate into VF.
  3. Magnesium 8mmol IV over 15 minutes is first choice
  4. Avoid anti-arrhythmic drugs
  5. Overdrive ventricular pacing
  6. Treat cause e.g. stop antiarrhythmia drugs, correct electrolyte abnormalities