Ventricular tachycardia classification: Difference between revisions

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Latest revision as of 13:11, 13 June 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]

Overview

Ventricular tachycardia refers to a rhythm with a heart rate in excess of 100 (and in some definitions 120) beats per minute that arises distal to the bundle of His. Ventricular tachycardia can be classified based on morphology and duration of tachyarrhythmia. The morphology of the QRS complexes on the ECG maybe (monomorphic ventricular tachycardiaor polymorphic ventricular tachycardia). In sustained VT duration of VT lasts > 30 sec or VT< 30 sec that needs to termination due to compromised hemodynamic. Nonsustained, or unsustained VT is more than 3 consecutive premature ventricular complexes with spontaneously termination. Bidirectional VT is a type of VT with beat to beat changing QRS frontal plane axis indicating of digoxin toxicity or catecholaminergic polymorphic VT.Torsades de pointed is a type of polymorphic VT in the setting of long QT interval which is characterized by twisting of the points, waxing and waning QRS amplitude, Long-short sequence with long-coupling interval to the first VT beat, maybe initiated after bradycardia such as high grade AV block.Ventricular flutter is explained as a regular ventricular arrhythmia with rate about 300 beat per minute (bpm), or cycle length 200 ms, sinusoidal monophorphic QRS complexes, Without any isoelecterical interval between successive QRS complexes. Ventricular fibrillation is a rapid, grossly irregular electrical activity with variation in morphologic waveforms by ventricular rate >300bpm, cycle length <200 ms. VT/ VF storm is an electerical storm or cardiac instability due to ≥ 3 episodes of sustained VT, VF or shock delivery from ICD within 24 hours.

Classification Based Upon Morphology of the QRS Complexes

Classification of ventriculat arrhythmia:

Term	Definition	Feature
Ventricular tachycardia^[1]	Presence of ≥ 3 consecutive premature ventricular complexes with the rate of >100 beats per minute or cycle length< 600 ms	^[2]
	Sustained VT	VT> 30 sec VT< 30 sec that needs to termination due to compromised hemodynamic
	Nonsustained, or unsustained VT	≥3 consecutive premature ventricular complexes, spontaneously termination
	Monomorphic VT	Uniform and stable beat to beat QRS morphology 12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)
	Polymorphic VT	Changing beat to beat QRS morphology Adopted from Wikipedia
	Bidirectional VT	VT with beat to beat changing QRS frontal plane axis, indicator of digoxin toxicity or catecholaminergic polymorphic VT
Torsades de pointes	A type of polymorphic VT Occurance in the setting of long QT interval Characterised by twisting of the points, waxing and waning QRS amplitude Long-short sequence with long-coupling interval to the first VT beat Maybe initiated after bradycardia such as high grade AV block	^[3]
Ventricular flutter	A regular ventricular arrhythmia Rate about 300 beat per minute (bpm), or cycle length 200 ms Sinusoidal monophorphic QRS complexes Without any isoelecterical interval between successive QRS complexes	^[4]
Ventricular fibrillation	Rapid, grossly irregular electrical activity Variation in morphologic waveforms Ventricular rate >300bpm, cycle length <200 ms	^[5]
VT, VF storm	Electerical storm or cardiac instability due to ≥ 3 episodes of sustained VT, VF or shock delivery from ICD within 24 hours

References

↑ "ACC/AHA/HRS 2006 Key Data Elements and Definitions for Electrophysiological Studies and Procedures". Circulation. 114 (23): 2534–2570. 2006. doi:10.1161/CIRCULATIONAHA.106.180199. ISSN 0009-7322.
↑ ECG found in of https://en.ecgpedia.org/index.php?title=Main_Page
↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page
↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page
↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page

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[1] "ACC/AHA/HRS 2006 Key Data Elements and Definitions for Electrophysiological Studies and Procedures". Circulation. 114 (23): 2534–2570. 2006. doi:10.1161/CIRCULATIONAHA.106.180199. ISSN 0009-7322.

[2] ECG found in of https://en.ecgpedia.org/index.php?title=Main_Page

[3] ECG found in https://en.ecgpedia.org/index.php?title=Main_Page

[4] ECG found in https://en.ecgpedia.org/index.php?title=Main_Page

[5] ECG found in https://en.ecgpedia.org/index.php?title=Main_Page

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[2]

[3]

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@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Ventricular tachycardia}}
+{{CMG}}; '''Associate Editor-In-Chief:''' {{Sara.Zand}} {{CZ}}
-{{CMG}}
+==Overview==
+[[Ventricular tachycardia]] refers to a [[rhythm]] with a [[heart rate]] in excess of 100 (and in some definitions 120) [[beats per minute]] that arises distal to the [[bundle of His]]. [[Ventricular tachycardia]] can be classified based on morphology and duration of [[tachyarrhythmia]]. The [[morphology]] of the [[QRS complexes]] on the [[ECG]] maybe ([[monomorphic ventricular tachycardia]]or [[polymorphic ventricular tachycardia]]). In sustained [[VT]]  duration of [[VT]] lasts > 30 sec or [[VT]]< 30 sec that needs to termination due to compromised [[hemodynamic]]. Nonsustained, or unsustained [[VT]] is more than 3 consecutive [[premature ventricular complexes]] with spontaneously termination. [[Bidirectional VT]] is a type of [[VT]] with  beat to beat changing [[QRS]] frontal plane [[axis]] indicating of [[digoxin toxicity]] or [[catecholaminergic polymorphic VT]].[[Torsades de pointed]] is a type of [[polymorphic VT]] in the setting of [[long QT]] interval which is characterized by [[twisting of the points]], waxing and waning [[QRS]] amplitude, Long-short sequence with long-coupling interval to the first [[VT]] beat, maybe initiated after [[bradycardia]] such as [[high grade AV block]].[[Ventricular flutter]]
+is explained as a regular [[ventricular arrhythmia]] with rate about 300 [[beat per minute]] (bpm), or cycle length 200 ms, [[sinusoidal]] [[monophorphic]] [[QRS]] complexes, [[Without]] any isoelecterical interval between successive [[QRS]] complexes. [[Ventricular fibrillation]] is a [[rapid]],  grossly irregular [[electrical]] activity with variation in morphologic waveforms by [[ventricular]] rate >300bpm, [[cycle length]] <200 ms. [[VT]]/ [[VF]] storm is an electerical storm or [[cardiac]] instability due to ≥ 3 episodes of sustained [[VT]], [[VF]] or shock delivery from [[ICD]] within 24 hours.
-'''Associate Editor-In-Chief:''' {{CZ}}
+==Classification Based Upon Morphology of the QRS Complexes==
-{{EH}}
+==== Classification of [[ventriculat arrhythmia]]: ====
+{| class="wikitable"
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Term
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Feature
+!
+|-
+| rowspan="6" |[[Ventricular tachycardia]]<ref>{{cite journal|title=ACC/AHA/HRS 2006 Key Data Elements and Definitions for Electrophysiological Studies and Procedures|journal=Circulation|volume=114|issue=23|year=2006|pages=2534–2570|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.180199}}</ref>
-==Classification Based Upon Morphology of Complexes==
+| Presence of ≥ 3 consecutive [[premature ventricular complexes]] with the rate of >100 [[beats]] per minute or [[cycle length]]< 600 ms
+|[[File:Capture V tach.PNG|center|300px]]<ref> ECG found in of https://en.ecgpedia.org/index.php?title=Main_Page </ref>
+*
+|
+|-
+|[[Sustained]] [[VT]]
+|
+* [[VT]]> 30 sec
+* [[VT]]< 30 sec that needs to termination due to compromised [[hemodynamic]]
+|
+|-
+|Nonsustained, or unsustained [[VT]]
+|
+* ≥3 consecutive [[premature ventricular complexes]], spontaneously termination
+|
+|-
+|[[Monomorphic]] [[VT]]
+|
+* Uniform and stable beat to beat [[QRS]] morphology
+*[[Image:Electrocardiogram of Ventricular Tachycardia.png|center|500px|12 lead [[electrocardiogram]] showing a run of monomorphic ventricular tachycardia (VT)]]
-Ventricular tachycardia can be classified based on its ''morphology'': [[Monomorphic ventricular tachycardia]] means that the appearance of all the beats match each other in each lead of a surface [[electrocardiogram]] (EKG).
+|
+|-
+|[[Polymorphic VT]]
+|
+*[[Changing]] beat to beat [[QRS]] morphology
+*[[File:Polymorphic vt.jpg|center|500 px|thumb|Adopted from Wikipedia]]
-[[Polymorphic ventricular tachycardia]], on the other hand, has beat-to-beat variations in morphology. This most commonly appears as a cyclical progressive change in cardiac axis referred to by its French eponym [[Torsade de pointes]] (literally twisting of the points).
+|
+|-
+|[[Bidirectional VT]]
+|
+*[[VT]] with beat to beat changing [[QRS]] frontal plane [[axis]], indicator of [[digoxin toxicity]] or [[catecholaminergic polymorphic VT]]
+|
+|-
+| rowspan="1" |[[Torsades de pointes]]
+|
+*A type of [[polymorphic VT]]
+*Occurance in the setting of [[long QT]] interval
+*Characterised by [[twisting of the points]], waxing and waning [[QRS]] amplitude
+* Long-short sequence with long-coupling interval to the first [[VT]] beat
+* Maybe initiated after [[bradycardia]] such as [[high grade AV block]]
+*
+|[[File:Capture Tors De P.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
+|
+|-
+|[[Ventricular flutter]]
+|
+* A regular [[ventricular arrhythmia]]
+* Rate about 300 [[beat per minute]] (bpm), or cycle length 200 ms
+* [[Sinusoidal]] [[monophorphic]] [[QRS]] complexes
+* [[Without]] any isoelecterical interval between successive [[QRS]] complexes
+|[[File:Capture Ven Flu.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
+|
+|-
+|[[Ventricular fibrillation]]
+|
+* [[Rapid]],  grossly irregular [[electrical]] activity
+* Variation in morphologic waveforms
+* [[Ventricular]] rate >300bpm, [[cycle length]] <200 ms
+|[[File:Capture VF.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
+|
+|-
+|[[VT]], [[VF]] storm
+|
+* Electerical storm or [[cardiac]] instability due to ≥ 3 episodes of sustained [[VT]], [[VF]] or shock delivery from [[ICD]] within 24 hours
-[[Image:Electrocardiogram of Ventricular Tachycardia.png|thumb|center|500px|12 lead [[electrocardiogram]] showing a run of monomorphic ventricular tachycardia (VT)]]
+|}
-==Classification Based Upon Duration of Episode==
+==References==
+{{reflist|2}}
-Another way to classify [[ventricular tachycardia]]s is the ''duration of the episodes'': Technically, three or more beats in a row on an EKG that originate from the ventricle at a rate of more than 100 beats per minute constitute a [[ventricular tachycardia]]. If the fast rhythm self-terminates within 30 seconds, it is considered a '''non-sustained ventricular tachycardia'''. If the rhythm lasts more than 30 seconds it is known as a '''sustained ventricular tachycardia''' (even if it terminates on its own after 30 seconds).
-===Sustained Ventricular Tachycardia===
-* Ventricular tachycardia originates from a ventricular focus
+[[Category:Disease]]
-* Lasts more than 30 seconds
+[[Category:Electrophysiology]]
-* Broad [[EKG|QRS]] complexes: rate of >90 beats/minute
+[[Category:Cardiology]]
+[[Category:Emergency medicine]]
-=== Paroxysmal Ventricular Tachycardia(Non Sustained Ventricular Tachycardia) ===
+[[Category:Intensive care medicine]]
+[[Category:Best pages]]
+[[Category:Up-To-Date cardiology]]
+[[Category:Up-To-Date]]
-* Rapid succession of three or more ectopic beats.
-* Sustained if it lasts longer than 30 seconds.
-===Incessant Ventricular Tachycardia===
-* The ventricular tachycardia is recurrent and the episodes are interrupted by only a few sinus beats.
-==Classification Based Upon Symptoms==
-A third way to classify [[ventricular tachycardia]] is on the basis of its symptoms: [[Pulseless VT]] is associated with no effective [[cardiac output]], hence, no effective pulse, and is a cause of [[cardiac arrest]]. In this circumstance it is best treated the same way as [[ventricular fibrillation]] ([[VF]]) and is recognized as one of the shockable rhythms on the [[cardiac arrest]] protocol. Some [[VT]] is associated with reasonable cardiac output and may even be asymptomatic. The heart usually tolerates this rhythm poorly in the medium to long term, and patients may certainly deteriorate to [[pulseless VT]] or to [[VF]].
-==References==
-{{reflist|2}}
 {{WH}}
 {{WS}}