Ventricular tachycardia diagnostic study of choice: Difference between revisions

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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{MIR}}
== Overview ==
== Overview ==
Simple [[ECG]] is the first initiative study of choice for diagnosing a ventricular tachycardia rhythm. Further investigations are necessary afterwards to confirm the cause of abnormal ventricular rhythm. Cardiac magnetic resonance is the gold standard test for the diagnosis of structural VT substrate. Cardiac magnetic resonance provides detailed assessment of cardiac morphology and function.
[[ECG]] is the first diagnostic test that should be obtained in hemodynamically stable [[Ventricular tachycardia]]. For detection of [[tachyarrhythmia]] [[symptoms]] related exercise such as [[cathecolaminergic polymorphic VT]], [[Exercise stress test]] is recommended. Findings on resting [[ECG]] associated with diagnosis of [[VT]] include evidence of  [[structural hear disease]] such as prior [[MI]] or [[chamber enlargement]], evidence of [[inherited arrhythmia disorders]] such as [[long QT syndrome]], [[Brugada syndrome]], [[arrhythmogenic right ventricular cardiomyopathy]]. [[QRS]] duration and [[conduction abnormality]] may have prognostic value in [[structural heart disease]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
Simple [[ECG]] is the first initiative study of choice for diagnosing a ventricular tachycardia rhythm. Further investigations are necessary afterwards to confirm the cause of abnormal ventricular rhythm.


=== Study of choice ===
Cardiac magnetic resonance is the gold standard test for the diagnosis of structural VT substrate.


Cardiac magnetic resonance provides:


* Excellent [[soft tissue]] image resolution
== 2017 AHA/ACC/HRS Guidelines for Management of [[Patients]] With [[Ventricular Arrhythmia]]s==
* Detailed assessment of cardiac morphology and function
* Let myocardial scar to be visualized precisely
** late gadolinium enhancement (LGE) is being considered as the most widely used technique for evaluating myocardial scar tissue by CMR. It is based on measurement of the signal intensity of LGE of scarred tissue which help defining the scar.


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].


OR


The following result of [gold standard test] is confirmatory of [disease name]:
{| class="wikitable"
* [Result 1]
|-
* [Result 2]
| Colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 
|-
OR
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>In [[patients]] with sustained, hemodynamically stable, [[wide QRS tachycardia ]], 12 leads [[ECG]] should be obtained '' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
 
|-
[Name of the investigation] must be performed when:
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>In [[patients]] with exercise induced [[ventricular tachyarrhythmia]] such as [[IHD]] or [[cathecolaminergic polymorphic VT]], exercise treadmill test is recommended'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>In [[patients]] with suspected or documented [[VT]], 12 leads [[ECG]] during [[sinus rhythm]] should be obtained for detecting [[structural heart disease]]'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki> [[Ambulatory electrocardiogram monitoring]] is recommended for [[patients]] presented  with [[palpitation]], [[syncope]], [[presyncope]] suspected [[ventricular arrhythmia]]'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''


There are no established criteria for the diagnosis of [disease name].
* 12-lead [[ECG]] is the first diagnostic test that should be obtained in hemodynamically stable [[Ventricular tachycardia]].
* For detection of [[tachyarrhythmia]] [[symptoms]] related exercise such as [[cathecolaminergic polymorphic VT]], [[Exercise stress test]] is recommended.
*Findings on [[ECG]] associated with [[VT]] include:
# Evidence of  [[structural hear disease]] such as prior [[MI]] or [[chamber enlargement]]
# Evidence of [[inherited arrhythmia disorders]] such as [[long QT syndrome]], [[Brugada syndrome]], [[arrhythmogenic right ventricular cardiomyopathy]]
*: [[QRS]] duration and [[conduction abnormality]] may have prognostic value in [[structural heart disease]].<ref name="BaldasseroniOpasich2002">{{cite journal|last1=Baldasseroni|first1=Samuele|last2=Opasich|first2=Cristina|last3=Gorini|first3=Marco|last4=Lucci|first4=Donata|last5=Marchionni|first5=Niccolò|last6=Marini|first6=Maurizio|last7=Campana|first7=Carlo|last8=Perini|first8=Giampaolo|last9=Deorsola|first9=Antonella|last10=Masotti|first10=Giulio|last11=Tavazzi|first11=Luigi|last12=Maggioni|first12=Aldo P.|title=Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure|journal=American Heart Journal|volume=143|issue=3|year=2002|pages=398–405|issn=00028703|doi=10.1067/mhj.2002.121264}}</ref>


==References==
==References==

Latest revision as of 05:31, 27 May 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Mahshid Mir, M.D. [3]

Overview

ECG is the first diagnostic test that should be obtained in hemodynamically stable Ventricular tachycardia. For detection of tachyarrhythmia symptoms related exercise such as cathecolaminergic polymorphic VT, Exercise stress test is recommended. Findings on resting ECG associated with diagnosis of VT include evidence of structural hear disease such as prior MI or chamber enlargement, evidence of inherited arrhythmia disorders such as long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy. QRS duration and conduction abnormality may have prognostic value in structural heart disease.

Diagnostic Study of Choice

2017 AHA/ACC/HRS Guidelines for Management of Patients With Ventricular Arrhythmias

Class I
"In patients with sustained, hemodynamically stable, wide QRS tachycardia , 12 leads ECG should be obtained (Level of Evidence B)"
"In patients with exercise induced ventricular tachyarrhythmia such as IHD or cathecolaminergic polymorphic VT, exercise treadmill test is recommended (Level of Evidence B)"
"In patients with suspected or documented VT, 12 leads ECG during sinus rhythm should be obtained for detecting structural heart disease (Level of Evidence B)"
" Ambulatory electrocardiogram monitoring is recommended for patients presented with palpitation, syncope, presyncope suspected ventricular arrhythmia (Level of Evidence B)"
  1. Evidence of structural hear disease such as prior MI or chamber enlargement
  2. Evidence of inherited arrhythmia disorders such as long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy

References

  1. ↑ Baldasseroni, Samuele; Opasich, Cristina; Gorini, Marco; Lucci, Donata; Marchionni, Niccolò; Marini, Maurizio; Campana, Carlo; Perini, Giampaolo; Deorsola, Antonella; Masotti, Giulio; Tavazzi, Luigi; Maggioni, Aldo P. (2002). "Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure". American Heart Journal. 143 (3): 398–405. doi:10.1067/mhj.2002.121264. ISSN 0002-8703.

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