Ventricular tachycardia classification: Difference between revisions

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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{Sara.Zand}} {{CZ}}


==Overview==
==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]] 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.
Ventricular tachycardia can be classified under three main categories:
#The morphology of complexes on EKG ([[monomorphic ventricular tachycardia]] vs [[polymorphic ventricular tachycardia]]
#The duration of the episode
#The symptoms associated with the episode


==Classification Based Upon Morphology of the QRS Complexes==
==Classification Based Upon Morphology of the QRS Complexes==
===[[Monomorphic ventricular tachycardia]]===
[[Monomorphic ventricular tachycardia]] is defined as a [[QRS complex]] morphology that is identical from beat-to-beat in all leads of the surface [[electrocardiogram]] (EKG).
[[Image:Electrocardiogram of Ventricular Tachycardia.png|thumb|center|500px|12 lead [[electrocardiogram]] showing a run of monomorphic ventricular tachycardia (VT)]]


===[[Polymorphic ventricular tachycardia]]===
==== Classification of [[ventriculat arrhythmia]]: ====
[[Polymorphic ventricular tachycardia]], is defined as [[QRS complexes]] with beat-to-beat variability 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).
{| class="wikitable"
====Example====
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Term
[[File:TdP.1.2.2.jpg|center|600px|Polymorphic VT]]
! 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 Duration of Episode==
| 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)]]


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).
|
|-
|[[Polymorphic VT]]
|
*[[Changing]] beat to beat [[QRS]] morphology
*[[File:Polymorphic vt.jpg|center|500 px|thumb|Adopted from Wikipedia]]


===Sustained Ventricular Tachycardia===
|
 
|-
* Ventricular tachycardia originates from a ventricular focus
|[[Bidirectional VT]]
* Lasts more than 30 seconds
|
* Broad [[EKG|QRS]] complexes: rate of >90 beats/minute
*[[VT]] with beat to beat changing [[QRS]] frontal plane [[axis]], indicator of [[digoxin toxicity]] or [[catecholaminergic polymorphic VT]]
|
=== Paroxysmal Ventricular Tachycardia(Non Sustained Ventricular Tachycardia) ===
 
* 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]].
 
{| border="0"
|-
|-
| Catecholamine-induced polymorphic ventricular tachycardia  [exact_synonym]
| rowspan="1" |[[Torsades de pointes]]
| • Catecholaminergic polymorphic ventricular tachycardia  [exact_synonym]
|
*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>
|
|-
|-
| • Familial polymorphic ventricular tachycardia  [exact_synonym]
|[[Ventricular flutter]]
| • Stress-induced polymorphic ventricular tachycardia  [exact_synonym]
|
* 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>
|
|-
|-
| • Catecholamine-induced polymorphic ventricular tachycardia  [synonym]
|[[Ventricular fibrillation]]
| • Catecholaminergic polymorphic ventricular tachycardia  [synonym]
|
* [[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>
|
|-
|-
| • Familial polymorphic ventricular tachycardia  [synonym]
|[[VT]], [[VF]] storm
| • Stress-induced polymorphic ventricular tachycardia
|
* Electerical storm or [[cardiac]] instability due to ≥ 3 episodes of sustained [[VT]], [[VF]] or shock delivery from [[ICD]] within 24 hours
 
|}
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Best pages]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date]]


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Latest revision as of 13:11, 13 June 2021

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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
Monomorphic VT
  • Uniform and stable beat to beat QRS morphology
  • 12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)
    12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)
Polymorphic VT
  • Changing beat to beat QRS morphology
  • Adopted from Wikipedia
Bidirectional VT
Torsades de pointes
[3]
Ventricular flutter
[4]
Ventricular fibrillation
[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

  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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