Ventricular tachycardia classification: Difference between revisions
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Direct-current [[cardioversion]] with appropriate [[sedation]] is recommended at any point in the treatment cascade in patients with suspected sustained monomorphic VT with [[hemodynamic compromise]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''. <nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Direct-current [[cardioversion]] with appropriate [[sedation]] is recommended at any point in the treatment cascade in patients with suspected sustained monomorphic VT with [[hemodynamic compromise]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''. <nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[procainamide]] (or ajmaline in some European countries) is reasonable for initial treatment of patients with stable sustained monomorphic VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Intravenous [[amiodarone]] is reasonable for patients with sustained monomorphic VT that is hemodynamically unstable, refractory to conversion with countershock, or recurrent despite [[procainamide]] or other agents. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Transvenous catheter pace termination can be useful to treat patients with sustained monomorphic VT that is refractory to cardioversion or is frequently recurrent despite antiarrhythmic medication. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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Revision as of 11:41, 29 October 2012
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Diagnosis |
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Treatment |
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Ventricular tachycardia classification On the Web |
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to Hospitals Treating Ventricular tachycardia classification |
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Risk calculators and risk factors for Ventricular tachycardia classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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 under three main categories:
- The morphology of the QRS complexes on the 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
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).
EKG Example
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Sustained Monomorphic Ventricular Tachycardia (DO NOT EDIT) [1]
| Class I |
| "1. Wide-QRS tachycardia should be presumed to be VT if the diagnosis is unclear. (Level of Evidence: C). " |
| "2. Direct-current cardioversion with appropriate sedation is recommended at any point in the treatment cascade in patients with suspected sustained monomorphic VT with hemodynamic compromise. (Level of Evidence: C). " |
| Class IIa |
| "1. Intravenous procainamide (or ajmaline in some European countries) is reasonable for initial treatment of patients with stable sustained monomorphic VT. (Level of Evidence: B)" |
| "2. Intravenous amiodarone is reasonable for patients with sustained monomorphic VT that is hemodynamically unstable, refractory to conversion with countershock, or recurrent despite procainamide or other agents. (Level of Evidence: C)" |
| "3. Transvenous catheter pace termination can be useful to treat patients with sustained monomorphic VT that is refractory to cardioversion or is frequently recurrent despite antiarrhythmic medication. (Level of Evidence: C)" |
Polymorphic ventricular tachycardia
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).
Example
Classification Based Upon Duration of Episode
Non Sustained Ventricular Tachycardia or Paroxysmal Ventricular Tachycardia
- Rapid succession of three or more ectopic beats
- Self terminates within 30 seconds
Sustained Ventricular Tachycardia
- Lasts more 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
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.
Perfusing Rhythm with VT
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
- ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.