Ventricular tachycardia electrocardiogram

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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]

Electrocardography(EKG)

Overview

The diagnosis of Ventricular tachycardia almost completely depends on EKG findings. The details are illustrated below. It is important to differentiate it from other wide complex tachycardias.

Electrocardiographic diagnostic findings

Ventricular tachycardia in Lead II (rhythm)

1. Abnormal and wide QRS complexes with secondary ST segment and T wave changes.
   
   • Usual QRS duration is > 0.12 seconds, may be shorter if the ectopic focus is located in the ventricular septum.
   • The secondary ST segment and T wave changes are in a direction that is opposite the major deflection of the QRS.
   • A ventricular rate between 140 and 200 BPM.
   • When the rate is >200 and has a sine wave appearance, it is called ventricular flutter.
   • When the rate is <110 BPM it is called non-paroxysmal VT.
2. A regular or slightly irregular (up to 0.03 seconds) rhythm.
   
3. Abrupt onset and termination.
   
4. AV dissociation.
   
   • Atrial rate slower than ventricular rate.
   • No relationship between atrial activity and ventricular activity.
   • There can be VA conduction.

     1. The RP interval is >0.11 seconds.
     2. Occurs in about 50% of cases.
     3. Uncommon when the ventricular rate is rapid (only 1/7 when the rate was>200).

5. Capture beats.
   
   • Occurs when a supraventricular impulse is conducted and captures the ventricle.
   • They are rare.
6. Fusion beats.
   
   • Rare in VT at a rapid rate.

Examples of Ventricular Tachycardia:

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  12 lead EKG: Ventricular tachycardia.

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  12 lead EKG: Ventricular tachycardia. Image courtesy of Dr Jose Ganseman

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  12 lead EKG: Ventricular tachycardia. Image courtesy of Dr Jose Ganseman

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  12 lead EKG: Ventricular tachycardia. Image courtesy of Dr Jose Ganseman

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  12 lead EKG: Ventricular tachycardia. Image courtesy of Dr Jose Ganseman

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  12 lead EKG: Ventricular tachycardia. Image courtesy of Dr Jose Ganseman

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  Ventricular tachycardia of 140 bpm with a left bundle branch block pattern and left heart axis.

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  Ventricular tachycardia of 250 bpm with a right bundle branch block pattern and right heart axis.

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  Ventricular tachycardia of 150 bpm with a right bundle branch block pattern and right heart axis. Note the 5th and 6th complex from the right side. These are fusion complexes.

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  Ventricular flutter on a 12 lead ECG