Ventricular tachycardia classification

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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 three main categories. Firstly, The morphology of the QRS complexes on the ECG (monomorphic ventricular tachycardia vs polymorphic ventricular tachycardia). Secondly, The duration of the episode. Thirdly, The symptoms associated with the episode.

Classification Based Upon Morphology of the QRS Complexes

Classification of ventriculat arrhythmia:

Term	Definition	Feature
Ventricular tachycardia	Presence of≥ 3 consecutive premature ventricular complexes with the rate of >100 beats per minute or cycle length< 600 ms	^[1]
	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	^[2]
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	^[3]
Ventricular fibrillation	Rapid, grossly irregular electrical activity Variation in morphologic waveforms Ventricular rate >300bpm, cycle length <200 ms	^[4]
VT, VF storm	Electerical storm or cardiac instability due to ≥ 3 episodes of sustained VT, VF or shock delivery from ICD within 24 hours