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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
{{CMG}}; '''Associate Editor-in Chief''': [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com]
{{CMG}}; '''Associate Editor-in Chief''': [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com]
==Overview==
In 1906 Gallavardin discovered the reasons behind the cardiac instability which leads to ventricular tachycardia, and put forth the idea that VT could convert into [[ventricular fibrillation]]. Thomas Lewis gave the first electrocardiographic description of ventricular tachycardia in 1909. It was first suggested in 1921 that coronary occlusion could the main cause of ventricular tachycardia. Many advancements have been made in the diagnosis and management protocols of ventricular tachycardia (VT) since that time.
==Historical Perspective==
==Historical Perspective==
=== Discovery ===
===Early Clinical and Experimental Observations===
===Early Clinical and Experimental Observations===
The first electrocardiographic description and evidence of [[Ventricular Tachycardia]] (VT) was given by [[Thomas Lewis]] in 1909. He described a patient with shortness of breath, precordial pain, and dropsy in whom he observed from three to eleven "successive [[extrasystoles]]".<ref>Lewis T(1909). Single and successive extrasystoles. ''Lancet'' 1:382.</ref> He deduced from the [[electrocardiogram]], venous pulse recording, and clinical evidence that the rhythm was of ventricular origin. In 1906, Einthoven had recorded [[Premature_ventricular_contraction|ventricular premature beats]] and ventricular [[bigeminy]] using his string galvanometer.<ref>Einthoven W(1906). Le telecardiogramme. ''Arch Int Physiol'' 4:132.</ref> In 1906 Gallavardin did landmark work in France in which he found the reason of instability of VT and its ability to convert in [[Ventricular Fibrillation]]. He challenged the fact that ventricular tachycardia was no more than a succession of [[extrasystoles]] suggesting that although the two phenomena were intimately related, the same mechanism might not be responsible for both.<ref>Gallavardin L(1922). Extrasystolie ventriculaire a paroxysmes tachycardiques prolonges. ''Arch Mal Coeur'' 15:298.</ref><ref>Gallavardin, L(1926). Tachycardie ventriculaire terminale: complexes alternants ou multiformes: ses rapports avec une forme severe d'extra-systolie ventriculaire. ''Arch Mal Coeur'' 19:153.</ref> Lewis and Smith did experimentation with dogs by simulating VT by ligating [[coronary arteries]] and was able to find characteristics of VT as we have described in the other sections.<ref>Lewis T(1909). The experimental production of paroxysmal tachycardia and the effects of ligation of the coronary arteries. ''Heart'' 1:98.</ref><ref>Smith FM(1918). The ligation of coronary arteries with electrocardiographic study. ''Arch Intern Med'', 22:8.</ref>
* The first electrocardiographic description and evidence of ventricular tachycardia (VT) was given by Thomas Lewis in 1909.<ref>Lewis T(1909). Single and successive extrasystoles. ''Lancet'' 1:382.</ref>
**He described a patient with [[shortness of breath]], [[precordial]] [[pain]], and dropsy in whom he observed from three to eleven successive [[extrasystoles]].
**He deduced from the [[electrocardiogram]], venous pulse recording, and clinical evidence that the rhythm was of [[ventricular]] origin.
 
* In 1906, Einthoven had recorded [[Premature_ventricular_contraction|ventricular premature beats]] and [[ventricular]] [[bigeminy]] using his string galvanometer.<ref>Einthoven W(1906). Le telecardiogramme. ''Arch Int Physiol'' 4:132.</ref>
 
* In 1906 Gallavardin did landmark work in France in which he found the reasons for instability in [[VT]] and its ability to convert in [[ventricular fibrillation]].<ref>Gallavardin L(1922). Extrasystolie ventriculaire a paroxysmes tachycardiques prolonges. ''Arch Mal Coeur'' 15:298.</ref><ref>Gallavardin, L(1926). Tachycardie ventriculaire terminale: complexes alternants ou multiformes: ses rapports avec une forme severe d'extra-systolie ventriculaire. ''Arch Mal Coeur'' 19:153.</ref>  
**He challenged the fact that ventricular tachycardia was no more than a succession of [[extrasystoles]] suggesting that although the two phenomena were intimately related, the same mechanism might not be responsible for both.
 
* Lewis and Smith did experimentation with dogs by simulating [[VT]] by ligating [[coronary arteries]] and were able to find characteristics of [[VT]] as we have described in the other sections.<ref>Lewis T(1909). The experimental production of paroxysmal tachycardia and the effects of ligation of the coronary arteries. ''Heart'' 1:98.</ref><ref>Smith FM(1918). The ligation of coronary arteries with electrocardiographic study. ''Arch Intern Med'', 22:8.</ref>
 
===[[Electrocardiographic]] Features===
* Robinson and Herrmann, in 1921, suggested that [[coronary occlusion]] was a frequent cause of [[ventricular tachycardia]] and the prognosis in these cases appeared to be poor.<ref>Robinson, GC, Herrmann CR(1921). Paroxysmal tachycardia of ventricular origin and its relation to coronary occlusion. ''Heart'' 8:59.</ref>
*They also suggested the most initial criteria for [[Ventricular_tachycardia_classification|VT classification]].
 
* That was modified later by Rosenberg as well as Dressler and Roesler who pointed out the occasional occurrence of [[fusion beats]] in tracings showing the [[arrhythmia]].<ref>Rosenberg DH(1940). Fusion beats. ''J Lab Clin Med'' 25:919.</ref><ref name="pmid12976333">{{cite journal| author=DRESSLER W, ROESLER H| title=The occurrence in paroxysmal ventricular tachycardia of ventricular complexes transitional in shape to sinoauricular beats; a diagnostic aid. | journal=Am Heart J | year= 1952 | volume= 44 | issue= 4 | pages= 485-93 | pmid=12976333 | doi= | pmc= | url= }} </ref>
 
* Since then we have come a long way in making of the diagnostic criteria better with advent of [[esophageal]] and [[Venous insufficiency|venous]] leads and invasive [[Electrophysiologic Testing or Electrophysiologic Studies for diagnosis of atrial fibrillation|electrophysiologic]] studies.<ref name="pmid623134">{{cite journal| author=Wellens HJ, Bär FW, Lie KI| title=The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. | journal=Am J Med | year= 1978 | volume= 64 | issue= 1 | pages= 27-33 | pmid=623134 | doi= | pmc= | url= }} </ref><ref name="pmid20278231">{{cite journal| author=BUTTERWORTH S, POINDEXTER CA| title=The esophageal electrocardiogram in arrhythmias and tachycardias. | journal=Am Heart J | year= 1946 | volume= 32 | issue= 6 | pages= 681-8 | pmid=20278231 | doi= | pmc= | url= }}</ref><ref name="pmid14118481">{{cite journal| author=VOGEL JH, TABARI K, AVERILL KH, BLOUNT SG| title=A SIMPLE TECHNIQUE FOR IDENTIFYING P WAVES IN COMPLEX ARRHYTHMIAS. | journal=Am Heart J | year= 1964 | volume= 67 | issue=  | pages= 158-61 | pmid=14118481 | doi= | pmc= | url= }}</ref>
 
* Holter and colleagues devised radio signal technique for obtaining a longer period of observation of the patient's rhythm.<ref name="pmid13908591">{{cite journal| author=HOLTER NJ| title=New method for heart studies. | journal=Science | year= 1961 | volume= 134 | issue=  | pages= 1214-20 | pmid=13908591 | doi= | pmc= | url= }} </ref>
*Later in development portable battery-operated electromagnetic tape recording with high-speed analyzing equipment was described by Holter and has been called [[Holter monitor]] ever since.<ref name="pmid13908591">{{cite journal| author=HOLTER NJ| title=New method for heart studies. | journal=Science | year= 1961 | volume= 134 | issue=  | pages= 1214-20 | pmid=13908591 | doi= | pmc= | url= }} </ref>
*This technique has led to discovery, classification and research for treatment of various forms of VT.
 
* Direct intracavitary recordings from the human [[ventricle]] were reported by Lenegre and Maurice in 1945.
*[[His bundle|Hiss bundle]] [[electrocardiogram]]s were described by Ciraud, Latour, and Puech in 1960.<ref name="lenegre">Lenegre I, Maurice P(1945): De quelques resultats obtenus par la derivation dired intracavitaire des courants electriques de l'oreillette et du ventricule droile. ''Arch Mal Coeur'' 38:298</ref><ref name="giraud">Giraud C, Latour H, Peuch P(1960). L'activite du noeud de Tawara et du faisceau de His en electrocardiographie chez l'homme. ''Malattie Cardiovascolari'' 1:321.</ref>
* It was only in 1969, however, that a safe, [[percutaneous]] method of recording the [[His bundle]] [[electrocardiogram]] in man was reported.<ref name="pmid5782803">{{cite journal| author=Scherlag BJ, Lau SH, Helfant RH, Berkowitz WD, Stein E, Damato AN| title=Catheter technique for recording His bundle activity in man. | journal=Circulation | year= 1969 | volume= 39 | issue= 1 | pages= 13-8 | pmid=5782803 | doi= | pmc= | url= }} </ref>
*Intracardiac recordings have allowed more precise diagnosis of ventricular tachycardia and have modified the electrocardiographic criteria for diagnosing this [[arrhythmia]].<ref name="pmid623134">{{cite journal| author=Wellens HJ, Bär FW, Lie KI| title=The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. | journal=Am J Med | year= 1978 | volume= 64 | issue= 1 | pages= 27-33 | pmid=623134 | doi= | pmc= | url= }} </ref>
 
* In 1972, Wellens et al. reported the initiation and termination of [[ventricular tachycardia]] in [[patients]] with prior[[ ventricular tachycardia]] using critically timed extrastimuli.<ref name="pmid4114692">{{cite journal| author=Wellens HJ, Schuilenburg RM, Durrer D| title=Electrical stimulation of the heart in patients with ventricular tachycardia. | journal=Circulation | year= 1972 | volume= 46 | issue= 2 | pages= 216-26 | pmid=4114692 | doi= | pmc= | url= }} </ref>
*This ability to initiate and terminate [[arrhythmia]]s under controlled circumstances, as well as the ability to record from multiple sites within the [[heart]], has allowed rapid advancement in our understanding of [[cardiac arrhythmia]]s.
 
* Initially [[Jugular_Venous_Pressure|phlebography]] was very popular amongst scientists for features of [[VT]].
* Prinzmetal and Kellogg in 1934 concluded that slower, independent [[JVP|A waves]] might be encountered in two-thirds of cases of [[VT]].<ref>Prinzmetal M, Kellogg F(1934): On the significance of the jugular pulse in the clinical diagnosis of ventricular tachycardia. ''Am Heart J'' 9:370. </ref>
 
* Schrire and Vogelpoel discovered that the so-called [[cannon A]] is encountered in presence of [[atrioventricular dissociation]], but could occur in regular fashion at the same rate in nodal [[tachycardia]]s.<ref name="pmid13228352">{{cite journal| author=SCHRIRE V, VOGELPOEL L| title=The clinical and electrocardiographic differentiation of supraventricular and ventricular tachycardias with regular rhythm. | journal=Am Heart J | year= 1955 | volume= 49 | issue= 2 | pages= 162-87 | pmid=13228352 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13228352  }} </ref>
 
* The [[AV dissociation]] and its reflection was demonstrated by Wilson et al. in 1964. <ref name="pmid14163224">{{cite journal| author=WILSON WS, JUDGE RD, SIEGEL JH| title=A SIMPLE DIAGNOSTIC SIGN IN VENTRICULAR TACHYCARDIA. | journal=N Engl J Med | year= 1964 | volume= 270 | issue=  | pages= 446-8 | pmid=14163224 | doi=10.1056/NEJM196402272700905 | pmc= | url= }} </ref>
 
* Levine was the first who noted slight irregularity in cycle length in [[patients]] with [[ventricular tachycardia]] which was audible with the [[stethoscope]].<ref>Strong CF, Levine SA(1923): The irregularity of the ventricular rate in paroxysmal ventricular tachycardia. ''Heart'' 10:125.</ref> In 1927, he mentioned variation in intensity of the [[first heart sound]], due to [[atrioventricular dissociation]], and extended these observations in conjunction with Harvey in 1948.<ref>Levine SA(1927). The clinical recognition of paroxysmal ventricular tachycardia. ''Am Heart J'' 3: 177.</ref><ref>Harvey WP, Levine SA(1948) The changing intensity of the first sound in auricular [[flutter]], an aid to the diagnosis by auscultation. ''Am Heart J'' 35:924.</ref>
 
* Harvey and Corrado demonstrated multiple low-frequency sounds audible in [[ventricular tachycardia]] as a differential point.<ref name="pmid13464935">{{cite journal| author=HARVEY WP, CORRADO MA| title=Multiple sounds in paroxysmal ventricular tachycardia; an aid in diagnosis by auscultation. | journal=N Engl J Med | year= 1957 | volume= 257 | issue= 7 | pages= 325-9 | pmid=13464935 | doi=10.1056/NEJM195708152570708 | pmc= | url= }} </ref>
 
* In 1930, Strauss<ref>Strauss MB(1930). Paroxysmal ventricular tachycardia . ''Am J Med Sci'' 179:337.</ref> correlated prognosis with the presence or absence of organic [[heart disease]]. It was noted that 60% of the cases occurred during the fifth and sixth decade of life, with a male preponderance.
 
*  [[Congestive heart failure]] was present in two-thirds of the patient population and [[digitalis]] had been administered before the onset of the tachycardia in half of the patients.
*[[Quinidine sulfate]] was acutely successful in controlling paroxysms in all cases in which it was employed. There were many other case series which had similar findings.<ref name="Lundy1934">Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref><ref>Riseman JEF, Linenthal H(1941).
 
*Paroxysmal ventricular tachycardia. Its favorable prognosis in the absence of acute cardiac damage and its treatment with parenterally administered [[quinine dihydrochloride]]. ''Am Heart J'' 22:219.</ref><ref>:Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref>Cooke WT, White PD(1943). Paroxysmal ventricular tachycardia. ''Br Heart J'' 5:33.</ref><ref name="Parkinson1947">Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref name="Hermann1948">Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref><ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref>
 
* Most investigators classified [[ventricular tachycardia]] into two forms on the basis of pattern and duration of the [[arrhythmia]].
*Intermittent [[ventricular tachycardia]] was defined as runs of [[ventricular tachycardia]] separated by periods of normal [[rhythm]], the latter often showing [[ventricular]] [[extrasystoles]] or short paroxysms of [[tachycardia]] lasting seconds or minutes which ceased spontaneously or were controlled readily in most cases by therapy. Persistent [[ventricular tachycardia]] was thereby defined as being of longer duration and without periods of interruption.<ref name="WilliamsVT">Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref>
 
* Several authors found important differences in prognosis between these groups.<ref name="WilliamsVT">Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref><ref name="pmid14196126">{{cite journal| author=MACKENZIE GJ, PASCUAL S| title=PAROXYSMAL VENTRICULAR TACHYCARDIA. | journal=Br Heart J | year= 1964 | volume= 26 | issue=  | pages= 441-51 | pmid=14196126 | doi= | pmc=PMC1018162 | url= }} </ref>


===Electrocardiographic Features===
* In all these series, the prognosis in patients with no identified organic [[heart disease]] was better than in those patients with abnormal [[hearts]].  
Robinson and Herrmann, in 1921, suggested that coronary occlusion was a frequent cause of [[ventricular tachycardia]] and the prognosis in these cases appeared to be poor.<ref>Robinson, GC, Herrmann CR(1921). Paroxysmal tachycardia of ventricular origin and its relation to coronary occlusion. ''Heart'' 8:59.</ref> They also suggested the most initial criteria for [[Ventricular_tachycardia_classification|VT classification]]. That was modified later by Rosenberg as well as Dressler and Roesler who pointed out the occasional occurrence of [[fusion beats]] in tracings showing the arrhythmia.<ref>Rosenberg DH(1940). Fusion beats. ''J Lab Clin Med'' 25:919.</ref><ref name="pmid12976333">{{cite journal| author=DRESSLER W, ROESLER H| title=The occurrence in paroxysmal ventricular tachycardia of ventricular complexes transitional in shape to sinoauricular beats; a diagnostic aid. | journal=Am Heart J | year= 1952 | volume= 44 | issue= 4 | pages= 485-93 | pmid=12976333 | doi= | pmc= | url= }} </ref> Since then we have come a long way in making of the diagnostic criteria better with advent of Esophageal<ref name="pmid20278231">{{cite journal| author=BUTTERWORTH S, POINDEXTER CA| title=The esophageal electrocardiogram in arrhythmias and tachycardias. | journal=Am Heart J | year= 1946 | volume= 32 | issue= 6 | pages= 681-8 | pmid=20278231 | doi= | pmc= | url= }} </ref><ref name="pmid14118481">{{cite journal| author=VOGEL JH, TABARI K, AVERILL KH, BLOUNT SG| title=A SIMPLE TECHNIQUE FOR IDENTIFYING P WAVES IN COMPLEX ARRHYTHMIAS. | journal=Am Heart J | year= 1964 | volume= 67 | issue=  | pages= 158-61 | pmid=14118481 | doi= | pmc= | url= }} </ref> & Venous leads and Invasive Electrophylogic Studies.<ref name="pmid623134">{{cite journal| author=Wellens HJ, Bär FW, Lie KI| title=The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. | journal=Am J Med | year= 1978 | volume= 64 | issue= 1 | pages= 27-33 | pmid=623134 | doi= | pmc= | url= }} </ref> Holter and colleagues devised radio signal technique for obtaining a longer period of observation of the patient's rhythm.<ref name="pmid13908591">{{cite journal| author=HOLTER NJ| title=New method for heart studies. | journal=Science | year= 1961 | volume= 134 | issue=  | pages= 1214-20 | pmid=13908591 | doi= | pmc= | url= }} </ref> Later in development portable battery-operated electromagnetic tape recording with high-speed analyzing equipment was described by Holter and has been called “[[Holter_monitor|Holter Monitor]]" ever since.<ref name="pmid13908591">{{cite journal| author=HOLTER NJ| title=New method for heart studies. | journal=Science | year= 1961 | volume= 134 | issue=  | pages= 1214-20 | pmid=13908591 | doi= | pmc= | url= }} </ref> This technique has led to discovery, classification and research for treatment of various forms of VT.
*Paroxysmal [[ventricular tachycardia]] in young patients with otherwise apparently healthy hearts was thought by several investigators to run a benign clinical course.<ref name="Parkinson1947">Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref name="pmid13041996">{{cite journal| author=FROMENT R, GALLAVARDIN L, CAHEN P| title=Paroxysmal ventricular tachycardia; a clinical classification. | journal=Br Heart J | year= 1953 | volume= 15 | issue= 2 | pages= 172-8 | pmid=13041996 | doi= | pmc=PMC479483 | url= }} </ref>
Direct intracavitary recordings from the human ventricle were reported by Lenegre and Maurice in 1945 and His bundle electrocardiograms were described by Ciraud, Latour, and Puech in 1960.<ref name = "lenegre">Lenegre I, Maurice P(1945): De quelques resultats obtenus par la derivation dired intracavitaire des courants electriques de l'oreillette et du ventricule droile. ''Arch Mal Coeur'' 38:298</ref><ref name = "giraud">Giraud C, Latour H, Peuch P(1960). L'activite du noeud de Tawara et du faisceau de His en electrocardiographie chez l'homme. ''Malattie Cardiovascolari'' 1:321.</ref> It was only in 1969, however, that a safe, percutaneous method of recording the His bundle electrocardiogram in man was reported.<ref name="pmid5782803">{{cite journal| author=Scherlag BJ, Lau SH, Helfant RH, Berkowitz WD, Stein E, Damato AN| title=Catheter technique for recording His bundle activity in man. | journal=Circulation | year= 1969 | volume= 39 | issue= 1 | pages= 13-8 | pmid=5782803 | doi= | pmc= | url= }} </ref> Intracardiac recordings have allowed more precise diagnosis of ventricular tachycardia and have modified the electrocardiographic criteria for diagnosing this arrhythmia.<ref name="pmid623134">{{cite journal| author=Wellens HJ, Bär FW, Lie KI| title=The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. | journal=Am J Med | year= 1978 | volume= 64 | issue= 1 | pages= 27-33 | pmid=623134 | doi= | pmc= | url= }} </ref> In 1972, Wellens et al. reported the initiation and termination of ventricular tachycardia in patients with prior ventricular tachycardia using critically timed extrastimuli.<ref name="pmid4114692">{{cite journal| author=Wellens HJ, Schuilenburg RM, Durrer D| title=Electrical stimulation of the heart in patients with ventricular tachycardia. | journal=Circulation | year= 1972 | volume= 46 | issue= 2 | pages= 216-26 | pmid=4114692 | doi= | pmc= | url= }} </ref> This ability to initiate and terminate arrhythmias under controlled circumstances, as well as the ability to record from multiple sites within the heart, has allowed rapid advancement in our understanding of cardiac arrhythmias.


===Physical Examination===
*  With the advent of more refined investigations such as [[cardiac catheterization]], [[echocardiography]], and [[endomyocardial biopsy]], anatomic and histologic details were found about the primary [[electrical]] disease.  
Initially [[Jugular_Venous_Pressure|Phlebography]] was very popular amongst scientists for features of VT. Prinzmetal and Kellogg in 1934 concluded that slower, independent A waves might be encountered in two-thirds of cases of VT.<ref>Prinzmetal M, Kellogg F(1934): On the significance of the jugular pulse in the clinical diagnosis of ventricular tachycardia. ''Am Heart J'' 9:370. </ref> Schrire and Vogelpoel discovered that the so-called "cannon" A is encountered in presence of atrioventricular dissociation, but could occur in regular fashion at the same rate in nodal tachycardias.<ref name="pmid13228352">{{cite journal| author=SCHRIRE V, VOGELPOEL L| title=The clinical and electrocardiographic differentiation of supraventricular and ventricular tachycardias with regular rhythm. | journal=Am Heart J | year= 1955 | volume= 49 | issue= 2 | pages= 162-87 | pmid=13228352 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13228352  }} </ref> The AV dissociation and its reflection was demonstrated by Wilson et al. in 1964. <ref name="pmid14163224">{{cite journal| author=WILSON WS, JUDGE RD, SIEGEL JH| title=A SIMPLE DIAGNOSTIC SIGN IN VENTRICULAR TACHYCARDIA. | journal=N Engl J Med | year= 1964 | volume= 270 | issue=  | pages= 446-8 | pmid=14163224 | doi=10.1056/NEJM196402272700905 | pmc= | url= }} </ref> Levine was the first who noted slight irregularity in cycle length in patients with [[ventricular tachycardia]] which was audible with the [[stethoscope]].<ref>Strong CF, Levine SA(1923): The irregularity of the ventricular rate in paroxysmal ventricular tachycardia. ''Heart'' 10:125.</ref> In 1927, he mentioned variation in intensity of the first heart sound, due to atrioventricular dissociation, and extended these observations in conjunction with Harvey in 1948.<ref>Levine SA(1927). The clinical recognition of paroxysmal ventricular tachycardia. ''Am Heart J'' 3: 177.</ref><ref>Harvey WP, Levine SA(1948) The changing intensity of the first sound in auricular flutter, an aid to the diagnosis hy auscultation. ''Am Heart J'' 35:924.</ref> Harvey and Corrado demonstrated multiple low-frequency sounds audible in [[ventricular tachycardia]] as a differential point.<ref name="pmid13464935">{{cite journal| author=HARVEY WP, CORRADO MA| title=Multiple sounds in paroxysmal ventricular tachycardia; an aid in diagnosis by auscultation. | journal=N Engl J Med | year= 1957 | volume= 257 | issue= 7 | pages= 325-9 | pmid=13464935 | doi=10.1056/NEJM195708152570708 | pmc= | url= }} </ref>


===Prognosis===
* Various investigators attempted to ascribe prognostic significance to morphologic characteristics of [[ventricular tachycardia]]. Lundy and McLellan categorized [[ventricular tachycardia]] by [[bundle branch pattern]] and assumed incorrectly the [[ventricular]] origin of the [[tachycardia]] from these morphologies.<ref name="Lundy1934">Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref>
In 1930, Strauss<ref>Strauss MB(1930). Paroxysmal ventricular tachycardia. ''Am J Med Sci'' 179:337.</ref> correlated prognosis with the presence or absence of organic heart disease. It was noted that 60% of the cases occurred during the fifth and sixth decade of life, with a male preponderance. [[Congestive heart failure]] was present in two-thirds of the patient population and [[digitalis]] had been administered before the onset of the tachycardia in half of the patients. [[Quinidine]] sulfate was acutely successful in controlling paroxysms in all cases in which it was employed. There were many other case series which had similar findings.<ref name="Lundy1934">Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref><ref>Riseman JEF, Linenthal H(1941). Paroxysmal ventricular tachycardia. Its favorable prognosis in the absence of acute cardiac damage and its treatment with parenterally administered quinine dihydrochloride. ''Am Heart J'' 22:219.</ref><ref>: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref>Cooke WT, White PD(1943). Paroxysmal ventricular tachycardia. ''Br Heart J'' 5:33.</ref><ref name="Parkinson1947">Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref name="Hermann1948">Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref><ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref> Most investigators classified [[ventricular tachycardia]] into two forms on the basis of pattern and duration of the arrhythmia. Interrmittent [[ventricular tachycardia]] was defined as "runs of ventricular tachycardia separated by periods of normal rhythm, the latter often showing ventricular [[extrasystoles]]"<ref name="WilliamsVT">Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref> or "short paroxysms of tachycardia lasting seconds or minutes which ceased spontaneously or were controlled readily in most cases by therapy." Persistent [[ventricular tachycardia]] was thereby defined as being of longer duration and without periods of interruption. Several authors found important differences in prognosis between these groups.<ref name="WilliamsVT">Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref><ref name="pmid14196126">{{cite journal| author=MACKENZIE GJ, PASCUAL S| title=PAROXYSMAL VENTRICULAR TACHYCARDIA. | journal=Br Heart J | year= 1964 | volume= 26 | issue=  | pages= 441-51 | pmid=14196126 | doi= | pmc=PMC1018162 | url= }} </ref> In all these series, the prognosis in patients with no identified organic heart disease was better than in those patients with abnormal hearts. Paroxysmal [[ventricular tachycardia]] in young patients with otherwise apparently healthy hearts was thought by several investigators to run a benign clinical course.<ref name="Parkinson1947">Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref name="pmid13041996">{{cite journal| author=FROMENT R, GALLAVARDIN L, CAHEN P| title=Paroxysmal ventricular tachycardia; a clinical classification. | journal=Br Heart J | year= 1953 | volume= 15 | issue= 2 | pages= 172-8 | pmid=13041996 | doi= | pmc=PMC479483 | url= }} </ref>
With advent of more refined investigations such as [[cardiac catheterization]], [[echocardiography]], and [[endomyocardial biopsy]], anatomic and histologic details were found about “primary electrical disease”. Various investigators attempted to ascribe prognostic significance to morphologic characteristics of ventricular tachycardia. Lundy and McLellan categorized ventricular tachycardia by bundle branch pattern and assumed incorrectly the ventricular origin of the tachycardias from these morphologies.<ref name="Lundy1934">Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref>
A distinctive form of ventricular tachycardia with beat-to-beat alteration of QRS axis in a single lead has been called “bidirectional” tachycardia and was first described by Schwensen in 1922.<ref>Schwensen, C: Ventricular tachycardia as a result of tho administration of digitalis. Heart. 9:199, 1922.</ref> He observed its occurrence during [[atrial fibrillation]] and linked it to digitalis intoxication. Palmer and White reported its poor prognosis.<ref>Palmer RS, White PD(1928): Paroxysmal ventricular tachycardia with rhythmic alternation in direction of the ventricular complexes in the electrocardiogram. ''Am Heart J'' 3:454.</ref> The studies which followed showed the same finding of poor prognosis with digitalis.<ref name="Herman1948">Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref>


===Drug Treatment===
* A distinctive form of [[ventricular tachycardia]] with [[beat-to-beat]] alteration of [[QRS axis]] in a single lead has been called [[bidirectional tachycardia ]] and was first described by Schwensen in 1922.<ref>Schwensen, C: Ventricular tachycardia as a result of tho administration of digitalis. Heart. 9:199, 1922.</ref>  
Scott in 1922 described a patient in whom [[Quinidine]] could both terminate and prevent episodes of [[Ventricular Tachycardia]].<ref>Scott RW(1922). Observations on a case of ventricular
**He observed its occurrence during [[atrial fibrillation]] and linked it to [[digitalis|digitalis intoxication]].
tachycardia with retrograde conduction. ''Heart'' 9:297.</ref> He also noticed that on discontinuing [[quinidine]] [[ventricular tachycardia]] recurred. He also hypothesized that quinidine abolished ventricular tachycardia by lengthening the refractory period of the ventricle, thereby preventing early [[premature ventricular beats]]. Drury and others demonstrated that [[quinidine]] prolonged the refractory period of ventricular muscle in dogs.<ref>Lewis T, Drury AN, Iliescu CC et al(1921). Observations relating to the action of quinidine upon the dog's heart, with special reference to its action on clinical fibrillation of the auricles. Heart, 9:55.</ref> Levine and Fulton noted that treatment with [[quinidine]] could either terminate episodes of [[ventricular tachycardia]] or it could cause them.<ref>Levine SA, Fulton MN(1929). The effects of quinidine sulphate on ventricular tachycardia. ''JAMA'' 92:1162.</ref> By 1950, Armbrust and Levine had followed a large population of patients and strongly advocated [[quinidine]] administration in the acute setting despite the difficulties associated with its use.<ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref> Procainamide was used to treat ventricular tachycardia in man in 1950 and rapidly achieved widespread use.<ref>Mark LC, Berlin I, Kayden HJ et al(1950): The action of procaine amide (N-2-diethylaminoethyl p-aminobenzamide) on ventricular arrhythmias. ''J Pharmacol Exper Therap'' 98:21.</ref><ref name="pmid13396938">{{cite journal| author=BRODIE BB, KAYDEN HJ, STEELE JM| title=Procaine amide; a review. | journal=Circulation | year= 1957 | volume= 15 | issue= 1 | pages= 118-26 | pmid=13396938 | doi= | pmc= | url= }} </ref> The first steps toward the development of [[procainamide]] had taken place many years earlier. In 1937, Beck and Mantz demonstrated that the topical application of procaine to the epicardium during surgical procedures reduced the occurrence of ventricular extrasystoles.<ref>Beck CS, Mautz FR(1937). The control of the heart beat by the surgeon witb special reference to ventricular fibrillation occurring during operation. ''Ann Surg'' 106:525.</ref> Procaine was limited to use under anesthesia because of its central nervous system toxicity. With further development of newer congeners, [[procainamide]] and [[lidocaine]] achieved wide clinical use. [[Lidocaine]] was synthesized in 1946 and was first used clinically by Southworth and colleagues to prevent ventricular arrhythmias during cardiac catheterization.<ref name="pmid15421803">{{cite journal| author=SOUTHWORTH JL, McKUSICK VA, PIERCE EC, RAWSON FL| title=Ventricular fibrillation precipitated by cardiac catheterization; complete recovery of the patient after 45 minutes. | journal=J Am Med Assoc | year= 1950 | volume= 143 | issue= 8 | pages= 717-20 | pmid=15421803 | doi= | pmc= | url= }} </ref> Other antiarrhythmic drugs quickly followed procainamide and lidocaine. [[Phenytoin]] was first used to treat ventricular tachycardia in 1958.<ref name="pmid13519913">{{cite journal| author=LEONARD WA| title=The use of diphenylhydantoin (dilantin) sodium in the treatment of ventricular tachycardia. | journal=AMA Arch Intern Med | year= 1958 | volume= 101 | issue= 4 | pages= 714-7 | pmid=13519913 | doi= | pmc= | url= }} </ref> In the 1960s a number of other drugs including beta-adrenergic blocking agents, [[disopyramide]], [[bretylium]], [[mexiletine]] and [[amiodarone]] were reported to be effective in treating ventricular arrhythmias in selected patients.<ref>Boyden PA, Wit AL(1983). Pharmacology of the antiarrhythmic drugs: In: MR Rosen, BF Hoffman(Eds). ''Cardiac Therapy Boston'', Martinus Nijhoff Publishers. </ref>


===Cardioversion and Defibrillation===
* Palmer and White reported its poor prognosis.<ref>Palmer RS, White PD(1928): Paroxysmal ventricular tachycardia with rhythmic alternation in direction of the [[ventricular]] complexes in the [[electrocardiogram]]. ''Am Heart J'' 3:454.</ref>
Once [[ventricular tachycardia]] had accelerated and become less organized, the likelihood of successful termination of the arrhythmia by drugs became more remote. Considerable experimental work had demonstrated the feasibility of using electric shocks to terminate [[ventricular fibrillation]] in a variety of experimental situations.<ref name = "hooker">Hooker DR, Kouwenhoven WB, Langworthy OR(1933). The effect of alternating electrical currents on the heart. ''Am J Physiol'' 103:444.</ref><ref name = "wiggers">Wiggers C](1940) The physiologic basis for cardiac resuscitation from ventricular fibrillation—method for serial defibrillation. ''Am Heart J'' 20: 413.</ref> Several chance events and experimental procedure had demonstrated the use of this procedure.<ref name = "beck">Beck CS, Pritchard WH, Feil HS(1947): Ventricular fibrillatiun of long duration abolished by electric shock. ''JAMA'' 135:985.</ref><ref name="pmid13309666">{{cite journal| author=ZOLL PM, LINENTHAL AJ, GIBSON W, PAUL MH, NORMAN LR| title=Termination of ventricular fibrillation in man by externally applied electric countershock. | journal=N Engl J Med | year= 1956 | volume= 254 | issue= 16 | pages= 727-32 | pmid=13309666 | doi=10.1056/NEJM195604192541601 | pmc= | url= }} </ref> In 1961, Alexander et al. used alternating current electively for the first time to terminate [[ventricular tachycardia]] that could not be stopped by giving [[antiarrhythmic drugs]].<ref name="pmid13682369">{{cite journal| author=ALEXANDER S, KLEIGER R, LOWN B| title=Use of external electric countershock in the treatment of [[ventricular tachycardia]]. | journal=JAMA | year= 1961 | volume= 177 | issue=  | pages= 916-8 | pmid=13682369 | doi= | pmc= | url= }} </ref> Over the subsequent few years, Lown and his colleagues greatly refined and popularized techniques for terminating [[tachyarrhythmias]] by electric discharges.<ref name="pmid13931298">{{cite journal| author=LOWN B, AMARASINGHAM R, NEUMAN J| title=New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. | journal=JAMA | year= 1962 | volume= 182 | issue=  | pages= 548-55 | pmid=13931298 | doi= | pmc= | url= }} </ref><ref name="pmid14466975">{{cite journal| author=LOWN B, NEUMAN J, AMARASINGHAM R, BERKOVITS BV| title=Comparison of alternating current with direct electroshock across the closed chest. | journal=Am J Cardiol | year= 1962 | volume= 10 | issue=  | pages= 223-33 | pmid=14466975 | doi= | pmc= | url= }} </ref><ref name="pmid6029120">{{cite journal| author=Lown B| title=Electrical reversion of cardiac arrhythmias. | journal=Br Heart J | year= 1967 | volume= 29 | issue= 4 | pages= 469-89 | pmid=6029120 | doi= | pmc=PMC487824 | url= }} </ref><ref name="pmid7004155">{{cite journal| author=DeSilva RA, Graboys TB, Podrid PJ, Lown B| title=Cardioversion and defibrillation. | journal=Am Heart J | year= 1980 | volume= 100 | issue= 6 Pt 1 | pages= 881-95 | pmid=7004155 | doi= | pmc= | url= }} </ref> Direct current (DC) or capacitor discharge was shown to be safer and more effective than alternating current. Synchronization of the direct current discharge to the R-wave resulted in safer termination of arrhythmias and was called "[[cardioversion]]” and was used for different kind of arrhythmias. Ventricular tachycardia could occasionally be terminated by [[Precordial_thump|thumping]] the chest in some patients.<ref name="pmid5472940">{{cite journal| author=Pennington JE, Taylor J, Lown B| title=Chest thump for reverting ventricular tachycardia. | journal=N Engl J Med | year= 1970 | volume= 283 | issue= 22 | pages= 1192-5 | pmid=5472940 | doi=10.1056/NEJM197011262832204 | pmc= | url= }} </ref> Defibrillation even using DC discharge required much higher energies, however. These techniques were quickly accepted around the world and truly revolutionized the treatment of cardiac [[tachyarrhythmias]]. Implantable devices capable of sensing and terminating [[ventricular tachycardia]] automatically by either [[defibrillation]] or [[cardioversion]] have come into clinical use.<ref name="pmid6991948">{{cite journal| author=Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF et al.| title=Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. | journal=N Engl J Med | year= 1980 | volume= 303 | issue= 6 | pages= 322-4 | pmid=6991948 | doi=10.1056/NEJM198008073030607 | pmc= | url= }} </ref>
*The studies which followed showed the same finding of poor prognosis with [[digitalis]].<ref name="Herman1948">Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref>
 
===Landmark Events in the Development of Treatment Strategies===
* Scott in 1922 described a patient in whom [[quinidine]] could both terminate and prevent episodes of [[ventricular tachycardia]].<ref>Scott RW(1922). Observations on a case of ventricular tachycardia with retrograde conduction. ''Heart'' 9:297.</ref>
**He also noticed that on discontinuing [[quinidine]] [[ventricular tachycardia]] recurred. He also hypothesized that [[quinidine]] abolished [[ventricular tachycardia]] by lengthening the refractory period of the [[ventricle]], thereby preventing early [[premature ventricular beats]].
 
* Drury and others demonstrated that [[quinidine]] prolonged the refractory period of [[ventricle|ventricular muscle]] in dogs.<ref>Lewis T, Drury AN, Iliescu CC et al(1921). Observations relating to the action of quinidine upon the dog's heart, with special reference to its action on clinical fibrillation of the auricles. Heart, 9:55.</ref>
 
* Levine and Fulton noted that treatment with [[quinidine]] could either terminate episodes of [[ventricular tachycardia]] or it could cause them.<ref>Levine SA, Fulton MN(1929). The effects of quinidine sulphate on ventricular tachycardia. ''JAMA'' 92:1162.</ref>
 
* By 1950, Armbrust and Levine had followed a large population of [[patients]] and strongly advocated [[quinidine]] administration in the acute setting despite the difficulties associated with its use.<ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref>
 
*  [[Procainamide]] was used to treat [[ventricular tachycardia]] in man in 1950 and rapidly achieved widespread use.<ref>Mark LC, Berlin I, Kayden HJ et al(1950): The action of procaine amide (N-2-diethylaminoethyl p-aminobenzamide) on ventricular arrhythmias. ''J Pharmacol Exper Therap'' 98:21.</ref><ref name="pmid13396938">{{cite journal| author=BRODIE BB, KAYDEN HJ, STEELE JM| title=Procaine amide; a review. | journal=Circulation | year= 1957 | volume= 15 | issue= 1 | pages= 118-26 | pmid=13396938 | doi= | pmc= | url= }} </ref>
 
* The first steps toward the development of [[procainamide]] had taken place many years earlier.
*In 1937, Beck and Mantz demonstrated that the topical application of [[procaine]] to the [[epicardium]] during surgical procedures reduced the occurrence of [[ventricular]] [[extrasystoles]].<ref>Beck CS, Mautz FR(1937). The control of the [[heart beat]] by the surgeon with special reference to [[ventricular fibrillation]] occurring during operation. ''Ann Surg'' 106:525.</ref>
 
*  [[Procaine]] was limited to use under [[anesthesia]] because of its [[central nervous system]] toxicity.
*With further development of newer congeners, [[procainamide]] and [[lidocaine]] achieved wide clinical use.
 
*  [[Lidocaine]] was synthesized in 1946 and was first used clinically by Southworth and colleagues to prevent [[ventricular arrhythmias]] during [[cardiac catheterization]].<ref name="pmid15421803">{{cite journal| author=SOUTHWORTH JL, McKUSICK VA, PIERCE EC, RAWSON FL| title=Ventricular fibrillation precipitated by cardiac catheterization; complete recovery of the patient after 45 minutes. | journal=J Am Med Assoc | year= 1950 | volume= 143 | issue= 8 | pages= 717-20 | pmid=15421803 | doi= | pmc= | url= }} </ref>
 
* Other [[antiarrhythmic drugs]] quickly followed [[procainamide]] and [[lidocaine]]. [[Phenytoin]] was first used to treat ventricular tachycardia in 1958.<ref name="pmid13519913">{{cite journal| author=LEONARD WA| title=The use of diphenylhydantoin (dilantin) sodium in the treatment of ventricular tachycardia. | journal=AMA Arch Intern Med | year= 1958 | volume= 101 | issue= 4 | pages= 714-7 | pmid=13519913 | doi= | pmc= | url= }} </ref>
 
* In the 1960s a number of other drugs including [[beta-adrenergic blocking agent]]s, [[disopyramide]], [[bretylium]], [[mexiletine]] and [[amiodarone]] were reported to be effective in treating ventricular arrhythmias in selected patients.<ref>Boyden PA, Wit AL(1983). Pharmacology of the antiarrhythmic drugs: In: MR Rosen, BF Hoffman(Eds). ''Cardiac Therapy Boston'', Martinus Nijhoff Publishers. </ref>
 
===[[Cardioversion]] and [[Defibrillation]]===
* Once [[ventricular tachycardia]] had accelerated and become less organized, the likelihood of successful termination of the [[arrhythmia]] by drugs became more remote. Considerable experimental work had demonstrated the feasibility of using electric shocks to terminate [[ventricular fibrillation]] in a variety of experimental situations.<ref name="hooker">Hooker DR, Kouwenhoven WB, Langworthy OR(1933). The effect of alternating electrical currents on the heart. ''Am J Physiol'' 103:444.</ref><ref name="wiggers">Wiggers C](1940) The physiologic basis for cardiac resuscitation from ventricular fibrillation—method for serial defibrillation. ''Am Heart J'' 20: 413.</ref>
 
* Several chance events and experimental procedure had demonstrated the use of this procedure.<ref name="beck">Beck CS, Pritchard WH, Feil HS(1947): Ventricular fibrillatiun of long duration abolished by electric shock. ''JAMA'' 135:985.</ref><ref name="pmid13309666">{{cite journal| author=ZOLL PM, LINENTHAL AJ, GIBSON W, PAUL MH, NORMAN LR| title=Termination of ventricular fibrillation in man by externally applied electric countershock. | journal=N Engl J Med | year= 1956 | volume= 254 | issue= 16 | pages= 727-32 | pmid=13309666 | doi=10.1056/NEJM195604192541601 | pmc= | url= }} </ref>
 
* In 1961, Alexander et al. used alternating current electively for the first time to terminate [[ventricular tachycardia]] that could not be stopped by giving [[antiarrhythmic drugs]].<ref name="pmid13682369">{{cite journal| author=ALEXANDER S, KLEIGER R, LOWN B| title=Use of external electric countershock in the treatment of [[ventricular tachycardia]]. | journal=JAMA | year= 1961 | volume= 177 | issue=  | pages= 916-8 | pmid=13682369 | doi= | pmc= | url= }} </ref>
 
* Over the subsequent few years, Lown and his colleagues greatly refined and popularized techniques for terminating [[tachyarrhythmias]] by electric discharges.<ref name="pmid13931298">{{cite journal| author=LOWN B, AMARASINGHAM R, NEUMAN J| title=New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. | journal=JAMA | year= 1962 | volume= 182 | issue=  | pages= 548-55 | pmid=13931298 | doi= | pmc= | url= }} </ref><ref name="pmid14466975">{{cite journal| author=LOWN B, NEUMAN J, AMARASINGHAM R, BERKOVITS BV| title=Comparison of alternating current with direct electroshock across the closed chest. | journal=Am J Cardiol | year= 1962 | volume= 10 | issue=  | pages= 223-33 | pmid=14466975 | doi= | pmc= | url= }} </ref><ref name="pmid6029120">{{cite journal| author=Lown B| title=Electrical reversion of cardiac arrhythmias. | journal=Br Heart J | year= 1967 | volume= 29 | issue= 4 | pages= 469-89 | pmid=6029120 | doi= | pmc=PMC487824 | url= }} </ref><ref name="pmid7004155">{{cite journal| author=DeSilva RA, Graboys TB, Podrid PJ, Lown B| title=Cardioversion and defibrillation. | journal=Am Heart J | year= 1980 | volume= 100 | issue= 6 Pt 1 | pages= 881-95 | pmid=7004155 | doi= | pmc= | url= }} </ref>
 
*[[ Direct current ]] ([[DC]]) or capacitor discharge was shown to be safer and more effective than alternating current.  
*[[Synchronization]] of the [[direct current]] discharge to the R-wave resulted in safer termination of [[arrhythmias]] and was called [[cardioversion]] and was used for different kinds of [[arrhythmias]].
 
* [[Ventricular tachycardia]] could occasionally be terminated by [[Precordial_thump|thumping]] the chest in some patients.<ref name="pmid5472940">{{cite journal| author=Pennington JE, Taylor J, Lown B| title=Chest thump for reverting ventricular tachycardia. | journal=N Engl J Med | year= 1970 | volume= 283 | issue= 22 | pages= 1192-5 | pmid=5472940 | doi=10.1056/NEJM197011262832204 | pmc= | url= }} </ref>
 
*  [[Defibrillation]] even using [[DC discharge ]] required much higher energies, however. These techniques were quickly accepted around the world and truly revolutionized the treatment of cardiac [[tachyarrhythmias]].  
*[[Implantable devices]] capable of sensing and terminating [[ventricular tachycardia]] automatically by either [[defibrillation]] or [[cardioversion]] have come into clinical use.<ref name="pmid6991948">{{cite journal| author=Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF et al.| title=Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. | journal=N Engl J Med | year= 1980 | volume= 303 | issue= 6 | pages= 322-4 | pmid=6991948 | doi=10.1056/NEJM198008073030607 | pmc= | url= }} </ref>


===Overdrive Pacing===
===Overdrive Pacing===
In 1960, Zoll and associates reported that increasing the heart rate by closed-chest cardiac stimulation had prevented recurrent [[ventricular tachyarrhythmias]].<ref name="pmid13847723">{{cite journal| author=ZOLI PM, LINENTHAL AJ, ZARSKY LR| title=Ventricular fibrillation: treatment and prevention by external electric currents. | journal=N Engl J Med | year= 1960 | volume= 262 | issue=  | pages= 105-12 | pmid=13847723 | doi=10.1056/NEJM196001212620301 | pmc= | url= }} </ref> They demonstrated that runs of [[ventricular fibrillation]] could be prevented by pacing the heart above a certain critical heart rate. In the same year, Schwedel, Escber. and Furman demonstrated similar short-term benefit from transvenous right ventricular endocardial pacing. <ref name="pmid14444092">{{cite journal| author=SCHWEDEL JB, FURMAN S, ESCHER DJ| title=Use of an intracardiac pacemaker in the treatment of Stokes-Adams seizures. | journal=Prog Cardiovasc Dis | year= 1960 | volume= 3 | issue=  | pages= 170-7 | pmid=14444092 | doi= | pmc= | url= }} </ref> Both the above experiments were in patients with heart block. Subsequently, Sowton and colleagues applied a similar technique in patients with [[ventricular tachycardia]] and [[fibrillation]] but without evidence of [[heart block]].<ref name="pmid14207900">{{cite journal| author=SOWTON E, LEATHAM A, CARSON P| title=THE SUPPRESSION OF ARRHYTHMIAS BY ARTIFICIAL PACEMAKING. | journal=Lancet | year= 1964 | volume= 2 | issue= 7369 | pages= 1098-100 | pmid=14207900 | doi= | pmc= | url= }} </ref> Apparently, pacing prevented episodes of [[tachyarrhythmia]] and [[extrasystoles]] in these patients. Furthermore, these authors suggested that the combined use of [[antiarrhythmic drugs]] and overdrive pacing might be better than the use of either modality alone in some patients. There were many case series and report of the use of overdrive pacing after this. These series are small with a limited follow-up period. Not all reports were favorable and long term outcomes were rarely available. Acute treatment of [[ventricular arrhythmias]] by overdrive pacing became accepted as effective in some patients.
* In 1960, Zoll and associates reported that increasing the heart rate by closed-chest cardiac stimulation had prevented recurrent [[ventricular tachyarrhythmias]].<ref name="pmid13847723">{{cite journal| author=ZOLI PM, LINENTHAL AJ, ZARSKY LR| title=Ventricular fibrillation: treatment and prevention by external electric currents. | journal=N Engl J Med | year= 1960 | volume= 262 | issue=  | pages= 105-12 | pmid=13847723 | doi=10.1056/NEJM196001212620301 | pmc= | url= }} </ref>
*They demonstrated that runs of [[ventricular fibrillation]] could be prevented by pacing the heart above a certain critical heart rate.
 
* In the same year, Schwedel, Escber. and Furman demonstrated similar short-term benefit from transvenous [[right ventricular]] endocardial pacing. <ref name="pmid14444092">{{cite journal| author=SCHWEDEL JB, FURMAN S, ESCHER DJ| title=Use of an intracardiac pacemaker in the treatment of Stokes-Adams seizures. | journal=Prog Cardiovasc Dis | year= 1960 | volume= 3 | issue=  | pages= 170-7 | pmid=14444092 | doi= | pmc= | url= }} </ref>


===Surgical Treatment===  
* Both the above experiments were in patients with [[heart block]]. Subsequently, Sowton and colleagues applied a similar technique in [[patients]] with [[ventricular tachycardia]] and [[fibrillation]] but without evidence of [[heart block]].<ref name="pmid14207900">{{cite journal| author=SOWTON E, LEATHAM A, CARSON P| title=THE SUPPRESSION OF ARRHYTHMIAS BY ARTIFICIAL PACEMAKING. | journal=Lancet | year= 1964 | volume= 2 | issue= 7369 | pages= 1098-100 | pmid=14207900 | doi= | pmc= | url= }} </ref>
In 1959 Couch reported on a patient in whom [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1243228/pdf/annsurg00064-0137.pdf|ventricular aneurysmectomy] was successfully performed to prevent recurrent ventricular tachycardia.<ref name="pmid13671713">{{cite journal| author=COUCH OA| title=Cardiac aneurysm with ventricular tachycardia and subsequent excision of aneurysm; case report. | journal=Circulation | year= 1959 | volume= 20 | issue= 2 | pages= 251-3 | pmid=13671713 | doi= | pmc= | url= }} </ref> But the procedure has been associated with poor success rates and surgical mortality of 20-50%.<ref name="pmid308302">{{cite journal| author=Sami M, Chaitman BR, Bourassa MG, Charpin D, Chabot M| title=Long term follow-up of aneurysmectomy for recurrent ventricular tachycardia or fibrillation. | journal=Am Heart J | year= 1978 | volume= 96 | issue= 3 | pages= 303-8 | pmid=308302 | doi= | pmc= | url= }} </ref><ref name="pmid7421287">{{cite journal| author=Harken AH, Horowitz LN, Josephson ME| title=Comparison of standard aneurysmectomy and aneurysmectomy with directed endocardial resection for the treatment of recurrent sustained ventricular tachycardia. | journal=J Thorac Cardiovasc Surg | year= 1980 | volume= 80 | issue= 4 | pages= 527-34 | pmid=7421287 | doi= | pmc= | url= }} </ref> Newer techniques include incising the margins of an aneurysm and excising these, and extensive endocardial scar excision combined with aneurysmectomy.<ref name="pmid753158">{{cite journal| author=Guiraudon G, Fontaine G, Frank R, Escande G, Etievent P, Cabrol C| title=Encircling endocardial ventriculotomy: a new surgical treatment for life-threatening ventricular tachycardias resistant to medical treatment following myocardial infarction. | journal=Ann Thorac Surg | year= 1978 | volume= 26 | issue= 5 | pages= 438-44 | pmid=753158 | doi= | pmc= | url= }} </ref><ref name="pmid51609">{{cite journal| author=Wittig JH, Boineau JP| title=Surgical treatment of ventricular arrhythmias using epicardial, transmural, and endocardial mapping. | journal=Ann Thorac Surg | year= 1975 | volume= 20 | issue= 2 | pages= 117-26 | pmid=51609 | doi= | pmc= | url= }} </ref><ref name="pmid498470">{{cite journal| author=Josephson ME, Harken AH, Horowitz LN| title=Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia. | journal=Circulation | year= 1979 | volume= 60 | issue= 7 | pages= 1430-9 | pmid=498470 | doi= | pmc= | url= }} </ref><ref name="pmid7138122">{{cite journal| author=Moran JM, Kehoe RF, Loeb JM, Lichtenthal PR, Sanders JH, Michaelis LL| title=Extended endocardial resection for the treatment of ventricular tachycardia and ventricular fibrillation. | journal=Ann Thorac Surg | year= 1982 | volume= 34 | issue= 5 | pages= 538-52 | pmid=7138122 | doi= | pmc= | url= }} </ref> [[Sympathectomy]], myocardial revascularization, and [[mitral valve replacement]] have also been tried for VT repair.<ref name = "mcgovern">McGovern B, DiMarco JP, Garan H(1983). New concepts in the management of ventricular arrhythmias and sudden death. ''Curr Probl Cardiol'' 7:1.</ref>
 
*  Apparently, pacing prevented episodes of [[tachyarrhythmia]] and [[extrasystoles]] in these patients. Furthermore, these authors suggested that the combined use of [[antiarrhythmic drugs]] and overdrive pacing might be better than the use of either modality alone in some [[patients]].
 
* There were many case series and reports of the use of [[overdrive pacing]] after this.
*These series are small with a limited follow-up period. Not all reports were favorable and long-term outcomes were rarely available.
*Acute treatment of [[ventricular arrhythmias]] by [[overdrive pacing ]] became accepted as effective in some [[patients]].
 
===Landmark Events in the Development of Surgical Treatment===  
* In 1959 Couch reported on a [[patient]] in whom [[ventricular aneurysmectomy]] was successfully performed to prevent recurrent [[ventricular tachycardia]].<ref name="pmid13671713">{{cite journal| author=COUCH OA| title=Cardiac aneurysm with ventricular tachycardia and subsequent excision of aneurysm; case report. | journal=Circulation | year= 1959 | volume= 20 | issue= 2 | pages= 251-3 | pmid=13671713 | doi= | pmc= | url= }} </ref><ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1243228/pdf/annsurg00064-0137.pdf</ref>
*But the procedure has been associated with poor success rates and surgical [[mortality]] of 20-50%.<ref name="pmid308302">{{cite journal| author=Sami M, Chaitman BR, Bourassa MG, Charpin D, Chabot M| title=Long term follow-up of aneurysmectomy for recurrent ventricular tachycardia or fibrillation. | journal=Am Heart J | year= 1978 | volume= 96 | issue= 3 | pages= 303-8 | pmid=308302 | doi= | pmc= | url= }} </ref><ref name="pmid7421287">{{cite journal| author=Harken AH, Horowitz LN, Josephson ME| title=Comparison of standard aneurysmectomy and aneurysmectomy with directed endocardial resection for the treatment of recurrent sustained ventricular tachycardia. | journal=J Thorac Cardiovasc Surg | year= 1980 | volume= 80 | issue= 4 | pages= 527-34 | pmid=7421287 | doi= | pmc= | url= }} </ref>
 
* Newer techniques include incising the margins of an aneurysm and excising these, and extensive [[endocardium|endocardial]] [[scar]] excision combined with [[ventricular aneurysmectomy|aneurysmectomy]].<ref name="pmid753158">{{cite journal| author=Guiraudon G, Fontaine G, Frank R, Escande G, Etievent P, Cabrol C| title=Encircling endocardial ventriculotomy: a new surgical treatment for life-threatening ventricular tachycardias resistant to medical treatment following myocardial infarction. | journal=Ann Thorac Surg | year= 1978 | volume= 26 | issue= 5 | pages= 438-44 | pmid=753158 | doi= | pmc= | url= }} </ref><ref name="pmid51609">{{cite journal| author=Wittig JH, Boineau JP| title=Surgical treatment of ventricular arrhythmias using epicardial, transmural, and endocardial mapping. | journal=Ann Thorac Surg | year= 1975 | volume= 20 | issue= 2 | pages= 117-26 | pmid=51609 | doi= | pmc= | url= }} </ref><ref name="pmid498470">{{cite journal| author=Josephson ME, Harken AH, Horowitz LN| title=Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia. | journal=Circulation | year= 1979 | volume= 60 | issue= 7 | pages= 1430-9 | pmid=498470 | doi= | pmc= | url= }} </ref><ref name="pmid7138122">{{cite journal| author=Moran JM, Kehoe RF, Loeb JM, Lichtenthal PR, Sanders JH, Michaelis LL| title=Extended endocardial resection for the treatment of ventricular tachycardia and ventricular fibrillation. | journal=Ann Thorac Surg | year= 1982 | volume= 34 | issue= 5 | pages= 538-52 | pmid=7138122 | doi= | pmc= | url= }} </ref>
 
*  [[Sympathectomy]], [[myocardium|myocardial]] [[revascularization]], and [[mitral valve replacement]] have also been tried for VT repair.<ref name="mcgovern">McGovern B, DiMarco JP, Garan H(1983). New concepts in the management of ventricular arrhythmias and sudden death. ''Curr Probl Cardiol'' 7:1.</ref>
 
===Choronology of Events===
{|border="1" align="center" style="background:lightskyblue"
|-
| bgcolor="CornFlowerBlue" |'''Year'''
| bgcolor="CornFlowerBlue" |'''Event'''
|-
| 1909
| First [[electrocardiographic]] demonstration of [[ventricular tachycardia]].
|-
| 1921
| Relationship of [[coronary artery disease]] and [[ventricular tachycardia]] described.
|-
| 1921
| Electrocardiographic criteria for [[ventricular tachycardia]] were defined.
|-
| 1922
| [[Quinidine]] used to treat [[ventricular tachycardia]].
|-
| 1946
| [[Lidocaine]] synthesized.
|-
| 1950
| [[Procainamide]] introduced into clinical practice.
|-
| 1956
| Alternating current used to terminate [[ventricular tachycardia]].
|-
| 1959
| [[Aneurysmectomy]] performed to treat [[ventricular tachycardia]].
|-
| 1960
| Use of [[cardiac]] [[pacing]] to prevent [[ventricular tachycardia]] in patients with [[complete heart block]].
|-
| 1960
| Elective alternating current termination of [[ventricular tachycardia]].
|-
| 1962
| [[Synchronized cardioversion]] of [[ventricular tachycardia]].
|-
| 1966
| [[Torsades de pointes]] described.
|-
| 1971
| [[Ventricular tachycardia ]]initiated and terminated by critically-timed [[premature ventricular beats]].
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 06:10, 21 May 2021

Ventricular tachycardia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]

Overview

In 1906 Gallavardin discovered the reasons behind the cardiac instability which leads to ventricular tachycardia, and put forth the idea that VT could convert into ventricular fibrillation. Thomas Lewis gave the first electrocardiographic description of ventricular tachycardia in 1909. It was first suggested in 1921 that coronary occlusion could the main cause of ventricular tachycardia. Many advancements have been made in the diagnosis and management protocols of ventricular tachycardia (VT) since that time.

Historical Perspective

Discovery

Early Clinical and Experimental Observations

  • The first electrocardiographic description and evidence of ventricular tachycardia (VT) was given by Thomas Lewis in 1909.[1]
  • In 1906 Gallavardin did landmark work in France in which he found the reasons for instability in VT and its ability to convert in ventricular fibrillation.[3][4]
    • He challenged the fact that ventricular tachycardia was no more than a succession of extrasystoles suggesting that although the two phenomena were intimately related, the same mechanism might not be responsible for both.
  • Lewis and Smith did experimentation with dogs by simulating VT by ligating coronary arteries and were able to find characteristics of VT as we have described in the other sections.[5][6]

Electrocardiographic Features

  • That was modified later by Rosenberg as well as Dressler and Roesler who pointed out the occasional occurrence of fusion beats in tracings showing the arrhythmia.[8][9]
  • Holter and colleagues devised radio signal technique for obtaining a longer period of observation of the patient's rhythm.[13]
  • Later in development portable battery-operated electromagnetic tape recording with high-speed analyzing equipment was described by Holter and has been called Holter monitor ever since.[13]
  • This technique has led to discovery, classification and research for treatment of various forms of VT.
  • It was only in 1969, however, that a safe, percutaneous method of recording the His bundle electrocardiogram in man was reported.[16]
  • Intracardiac recordings have allowed more precise diagnosis of ventricular tachycardia and have modified the electrocardiographic criteria for diagnosing this arrhythmia.[10]
  • Initially phlebography was very popular amongst scientists for features of VT.
  • Prinzmetal and Kellogg in 1934 concluded that slower, independent A waves might be encountered in two-thirds of cases of VT.[18]
  • In 1930, Strauss[25] correlated prognosis with the presence or absence of organic heart disease. It was noted that 60% of the cases occurred during the fifth and sixth decade of life, with a male preponderance.
  • Several authors found important differences in prognosis between these groups.[34][33][35]
  • In all these series, the prognosis in patients with no identified organic heart disease was better than in those patients with abnormal hearts.
  • Paroxysmal ventricular tachycardia in young patients with otherwise apparently healthy hearts was thought by several investigators to run a benign clinical course.[30][36]
  • Palmer and White reported its poor prognosis.[38]
  • The studies which followed showed the same finding of poor prognosis with digitalis.[39][33]

Landmark Events in the Development of Treatment Strategies

  • By 1950, Armbrust and Levine had followed a large population of patients and strongly advocated quinidine administration in the acute setting despite the difficulties associated with its use.[32]

Cardioversion and Defibrillation

  • Once ventricular tachycardia had accelerated and become less organized, the likelihood of successful termination of the arrhythmia by drugs became more remote. Considerable experimental work had demonstrated the feasibility of using electric shocks to terminate ventricular fibrillation in a variety of experimental situations.[49][50]
  • Several chance events and experimental procedure had demonstrated the use of this procedure.[51][52]
  • Over the subsequent few years, Lown and his colleagues greatly refined and popularized techniques for terminating tachyarrhythmias by electric discharges.[54][55][56][57]

Overdrive Pacing

  • In 1960, Zoll and associates reported that increasing the heart rate by closed-chest cardiac stimulation had prevented recurrent ventricular tachyarrhythmias.[60]
  • They demonstrated that runs of ventricular fibrillation could be prevented by pacing the heart above a certain critical heart rate.
  • In the same year, Schwedel, Escber. and Furman demonstrated similar short-term benefit from transvenous right ventricular endocardial pacing. [61]
  • There were many case series and reports of the use of overdrive pacing after this.
  • These series are small with a limited follow-up period. Not all reports were favorable and long-term outcomes were rarely available.
  • Acute treatment of ventricular arrhythmias by overdrive pacing became accepted as effective in some patients.

Landmark Events in the Development of Surgical Treatment

Choronology of Events

Year Event
1909 First electrocardiographic demonstration of ventricular tachycardia.
1921 Relationship of coronary artery disease and ventricular tachycardia described.
1921 Electrocardiographic criteria for ventricular tachycardia were defined.
1922 Quinidine used to treat ventricular tachycardia.
1946 Lidocaine synthesized.
1950 Procainamide introduced into clinical practice.
1956 Alternating current used to terminate ventricular tachycardia.
1959 Aneurysmectomy performed to treat ventricular tachycardia.
1960 Use of cardiac pacing to prevent ventricular tachycardia in patients with complete heart block.
1960 Elective alternating current termination of ventricular tachycardia.
1962 Synchronized cardioversion of ventricular tachycardia.
1966 Torsades de pointes described.
1971 Ventricular tachycardia initiated and terminated by critically-timed premature ventricular beats.

References

  1. ↑ Lewis T(1909). Single and successive extrasystoles. Lancet 1:382.
  2. ↑ Einthoven W(1906). Le telecardiogramme. Arch Int Physiol 4:132.
  3. ↑ Gallavardin L(1922). Extrasystolie ventriculaire a paroxysmes tachycardiques prolonges. Arch Mal Coeur 15:298.
  4. ↑ Gallavardin, L(1926). Tachycardie ventriculaire terminale: complexes alternants ou multiformes: ses rapports avec une forme severe d'extra-systolie ventriculaire. Arch Mal Coeur 19:153.
  5. ↑ Lewis T(1909). The experimental production of paroxysmal tachycardia and the effects of ligation of the coronary arteries. Heart 1:98.
  6. ↑ Smith FM(1918). The ligation of coronary arteries with electrocardiographic study. Arch Intern Med, 22:8.
  7. ↑ Robinson, GC, Herrmann CR(1921). Paroxysmal tachycardia of ventricular origin and its relation to coronary occlusion. Heart 8:59.
  8. ↑ Rosenberg DH(1940). Fusion beats. J Lab Clin Med 25:919.
  9. ↑ DRESSLER W, ROESLER H (1952). "The occurrence in paroxysmal ventricular tachycardia of ventricular complexes transitional in shape to sinoauricular beats; a diagnostic aid". Am Heart J. 44 (4): 485–93. PMID 12976333.
  10. ↑ 10.0 10.1 Wellens HJ, Bär FW, Lie KI (1978). "The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex". Am J Med. 64 (1): 27–33. PMID 623134.
  11. ↑ BUTTERWORTH S, POINDEXTER CA (1946). "The esophageal electrocardiogram in arrhythmias and tachycardias". Am Heart J. 32 (6): 681–8. PMID 20278231.
  12. ↑ VOGEL JH, TABARI K, AVERILL KH, BLOUNT SG (1964). "A SIMPLE TECHNIQUE FOR IDENTIFYING P WAVES IN COMPLEX ARRHYTHMIAS". Am Heart J. 67: 158–61. PMID 14118481.
  13. ↑ 13.0 13.1 HOLTER NJ (1961). "New method for heart studies". Science. 134: 1214–20. PMID 13908591.
  14. ↑ Lenegre I, Maurice P(1945): De quelques resultats obtenus par la derivation dired intracavitaire des courants electriques de l'oreillette et du ventricule droile. Arch Mal Coeur 38:298
  15. ↑ Giraud C, Latour H, Peuch P(1960). L'activite du noeud de Tawara et du faisceau de His en electrocardiographie chez l'homme. Malattie Cardiovascolari 1:321.
  16. ↑ Scherlag BJ, Lau SH, Helfant RH, Berkowitz WD, Stein E, Damato AN (1969). "Catheter technique for recording His bundle activity in man". Circulation. 39 (1): 13–8. PMID 5782803.
  17. ↑ Wellens HJ, Schuilenburg RM, Durrer D (1972). "Electrical stimulation of the heart in patients with ventricular tachycardia". Circulation. 46 (2): 216–26. PMID 4114692.
  18. ↑ Prinzmetal M, Kellogg F(1934): On the significance of the jugular pulse in the clinical diagnosis of ventricular tachycardia. Am Heart J 9:370.
  19. ↑ SCHRIRE V, VOGELPOEL L (1955). "The clinical and electrocardiographic differentiation of supraventricular and ventricular tachycardias with regular rhythm". Am Heart J. 49 (2): 162–87. PMID 13228352.
  20. ↑ WILSON WS, JUDGE RD, SIEGEL JH (1964). "A SIMPLE DIAGNOSTIC SIGN IN VENTRICULAR TACHYCARDIA". N Engl J Med. 270: 446–8. doi:10.1056/NEJM196402272700905. PMID 14163224.
  21. ↑ Strong CF, Levine SA(1923): The irregularity of the ventricular rate in paroxysmal ventricular tachycardia. Heart 10:125.
  22. ↑ Levine SA(1927). The clinical recognition of paroxysmal ventricular tachycardia. Am Heart J 3: 177.
  23. ↑ Harvey WP, Levine SA(1948) The changing intensity of the first sound in auricular flutter, an aid to the diagnosis by auscultation. Am Heart J 35:924.
  24. ↑ HARVEY WP, CORRADO MA (1957). "Multiple sounds in paroxysmal ventricular tachycardia; an aid in diagnosis by auscultation". N Engl J Med. 257 (7): 325–9. doi:10.1056/NEJM195708152570708. PMID 13464935.
  25. ↑ Strauss MB(1930). Paroxysmal ventricular tachycardia . Am J Med Sci 179:337.
  26. ↑ 26.0 26.1 Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. Ann Intern Med 7:812.
  27. ↑ Riseman JEF, Linenthal H(1941).
    • Paroxysmal ventricular tachycardia. Its favorable prognosis in the absence of acute cardiac damage and its treatment with parenterally administered quinine dihydrochloride. Am Heart J 22:219.
  28. ↑ :Ventricular tachycardia: an analysis of 36 cases. Arch Intern Med 71:137.
  29. ↑ Cooke WT, White PD(1943). Paroxysmal ventricular tachycardia. Br Heart J 5:33.
  30. ↑ 30.0 30.1 Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. Br Heart J 9:241.
  31. ↑ Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. Ann Intern Med 28:989.
  32. ↑ 32.0 32.1 ARMBRUST CA, LEVINE SA (1950). "Paroxysmal ventricular tachycardia; a study of 107 cases". Circulation. 1 (1): 28–40. PMID 15401194.
  33. ↑ 33.0 33.1 33.2 HERRMANN GR, PARK HM, HEJTMANCIK MR (1959). "Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study". Am Heart J. 57 (2): 166–76. PMID 13617190.
  34. ↑ 34.0 34.1 Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. Arch Intern Med 71:137.
  35. ↑ MACKENZIE GJ, PASCUAL S (1964). "PAROXYSMAL VENTRICULAR TACHYCARDIA". Br Heart J. 26: 441–51. PMC 1018162. PMID 14196126.
  36. ↑ FROMENT R, GALLAVARDIN L, CAHEN P (1953). "Paroxysmal ventricular tachycardia; a clinical classification". Br Heart J. 15 (2): 172–8. PMC 479483. PMID 13041996.
  37. ↑ Schwensen, C: Ventricular tachycardia as a result of tho administration of digitalis. Heart. 9:199, 1922.
  38. ↑ Palmer RS, White PD(1928): Paroxysmal ventricular tachycardia with rhythmic alternation in direction of the ventricular complexes in the electrocardiogram. Am Heart J 3:454.
  39. ↑ Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. Ann Intern Med 28:989.
  40. ↑ Scott RW(1922). Observations on a case of ventricular tachycardia with retrograde conduction. Heart 9:297.
  41. ↑ Lewis T, Drury AN, Iliescu CC et al(1921). Observations relating to the action of quinidine upon the dog's heart, with special reference to its action on clinical fibrillation of the auricles. Heart, 9:55.
  42. ↑ Levine SA, Fulton MN(1929). The effects of quinidine sulphate on ventricular tachycardia. JAMA 92:1162.
  43. ↑ Mark LC, Berlin I, Kayden HJ et al(1950): The action of procaine amide (N-2-diethylaminoethyl p-aminobenzamide) on ventricular arrhythmias. J Pharmacol Exper Therap 98:21.
  44. ↑ BRODIE BB, KAYDEN HJ, STEELE JM (1957). "Procaine amide; a review". Circulation. 15 (1): 118–26. PMID 13396938.
  45. ↑ Beck CS, Mautz FR(1937). The control of the heart beat by the surgeon with special reference to ventricular fibrillation occurring during operation. Ann Surg 106:525.
  46. ↑ SOUTHWORTH JL, McKUSICK VA, PIERCE EC, RAWSON FL (1950). "Ventricular fibrillation precipitated by cardiac catheterization; complete recovery of the patient after 45 minutes". J Am Med Assoc. 143 (8): 717–20. PMID 15421803.
  47. ↑ LEONARD WA (1958). "The use of diphenylhydantoin (dilantin) sodium in the treatment of ventricular tachycardia". AMA Arch Intern Med. 101 (4): 714–7. PMID 13519913.
  48. ↑ Boyden PA, Wit AL(1983). Pharmacology of the antiarrhythmic drugs: In: MR Rosen, BF Hoffman(Eds). Cardiac Therapy Boston, Martinus Nijhoff Publishers.
  49. ↑ Hooker DR, Kouwenhoven WB, Langworthy OR(1933). The effect of alternating electrical currents on the heart. Am J Physiol 103:444.
  50. ↑ Wiggers C](1940) The physiologic basis for cardiac resuscitation from ventricular fibrillation—method for serial defibrillation. Am Heart J 20: 413.
  51. ↑ Beck CS, Pritchard WH, Feil HS(1947): Ventricular fibrillatiun of long duration abolished by electric shock. JAMA 135:985.
  52. ↑ ZOLL PM, LINENTHAL AJ, GIBSON W, PAUL MH, NORMAN LR (1956). "Termination of ventricular fibrillation in man by externally applied electric countershock". N Engl J Med. 254 (16): 727–32. doi:10.1056/NEJM195604192541601. PMID 13309666.
  53. ↑ ALEXANDER S, KLEIGER R, LOWN B (1961). "Use of external electric countershock in the treatment of ventricular tachycardia". JAMA. 177: 916–8. PMID 13682369.
  54. ↑ LOWN B, AMARASINGHAM R, NEUMAN J (1962). "New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge". JAMA. 182: 548–55. PMID 13931298.
  55. ↑ LOWN B, NEUMAN J, AMARASINGHAM R, BERKOVITS BV (1962). "Comparison of alternating current with direct electroshock across the closed chest". Am J Cardiol. 10: 223–33. PMID 14466975.
  56. ↑ Lown B (1967). "Electrical reversion of cardiac arrhythmias". Br Heart J. 29 (4): 469–89. PMC 487824. PMID 6029120.
  57. ↑ DeSilva RA, Graboys TB, Podrid PJ, Lown B (1980). "Cardioversion and defibrillation". Am Heart J. 100 (6 Pt 1): 881–95. PMID 7004155.
  58. ↑ Pennington JE, Taylor J, Lown B (1970). "Chest thump for reverting ventricular tachycardia". N Engl J Med. 283 (22): 1192–5. doi:10.1056/NEJM197011262832204. PMID 5472940.
  59. ↑ Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF; et al. (1980). "Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings". N Engl J Med. 303 (6): 322–4. doi:10.1056/NEJM198008073030607. PMID 6991948.
  60. ↑ ZOLI PM, LINENTHAL AJ, ZARSKY LR (1960). "Ventricular fibrillation: treatment and prevention by external electric currents". N Engl J Med. 262: 105–12. doi:10.1056/NEJM196001212620301. PMID 13847723.
  61. ↑ SCHWEDEL JB, FURMAN S, ESCHER DJ (1960). "Use of an intracardiac pacemaker in the treatment of Stokes-Adams seizures". Prog Cardiovasc Dis. 3: 170–7. PMID 14444092.
  62. ↑ SOWTON E, LEATHAM A, CARSON P (1964). "THE SUPPRESSION OF ARRHYTHMIAS BY ARTIFICIAL PACEMAKING". Lancet. 2 (7369): 1098–100. PMID 14207900.
  63. ↑ COUCH OA (1959). "Cardiac aneurysm with ventricular tachycardia and subsequent excision of aneurysm; case report". Circulation. 20 (2): 251–3. PMID 13671713.
  64. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1243228/pdf/annsurg00064-0137.pdf
  65. ↑ Sami M, Chaitman BR, Bourassa MG, Charpin D, Chabot M (1978). "Long term follow-up of aneurysmectomy for recurrent ventricular tachycardia or fibrillation". Am Heart J. 96 (3): 303–8. PMID 308302.
  66. ↑ Harken AH, Horowitz LN, Josephson ME (1980). "Comparison of standard aneurysmectomy and aneurysmectomy with directed endocardial resection for the treatment of recurrent sustained ventricular tachycardia". J Thorac Cardiovasc Surg. 80 (4): 527–34. PMID 7421287.
  67. ↑ Guiraudon G, Fontaine G, Frank R, Escande G, Etievent P, Cabrol C (1978). "Encircling endocardial ventriculotomy: a new surgical treatment for life-threatening ventricular tachycardias resistant to medical treatment following myocardial infarction". Ann Thorac Surg. 26 (5): 438–44. PMID 753158.
  68. ↑ Wittig JH, Boineau JP (1975). "Surgical treatment of ventricular arrhythmias using epicardial, transmural, and endocardial mapping". Ann Thorac Surg. 20 (2): 117–26. PMID 51609.
  69. ↑ Josephson ME, Harken AH, Horowitz LN (1979). "Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia". Circulation. 60 (7): 1430–9. PMID 498470.
  70. ↑ Moran JM, Kehoe RF, Loeb JM, Lichtenthal PR, Sanders JH, Michaelis LL (1982). "Extended endocardial resection for the treatment of ventricular tachycardia and ventricular fibrillation". Ann Thorac Surg. 34 (5): 538–52. PMID 7138122.
  71. ↑ McGovern B, DiMarco JP, Garan H(1983). New concepts in the management of ventricular arrhythmias and sudden death. Curr Probl Cardiol 7:1.


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