ventricular tachycardia

Dr Ramachandra

VentricularTachycardia

“I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the sea-shore, and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, whilst the great ocean of truth lay all undiscovered before me.” ― Isaac Newton

DefineArrhythmiaHR≥100/min Originates in the ventriclesWide QRS complexes (120 ms)

TypesIdiopathic vs. structuralSustained (>30sec) vs. non sustainedMonomorphic vs. polymorphic(≥5

continuous QRS has no clear isoelectric baseline)

With or without hemodynamic collapse

DiagnosisECG is enoughWide QRS:80% VT :20% SVT with

aberrancy/AVRT/etc

VT Cousins

VT Cousins

concordance=PolarityNegative: All QRS in V1-6 -VEPositive: All QRS in V1-6 +VE

ECG

QRS in MI looks Spine or sternum?

Poor R-wave progression and VT

Where they came from?

Bundle branch reentry -VT

Idiopathic Monomorphic VT

Aortic cusp-VT

Medical Rx of VT

Amiodarone….Contid

Major ICD trials

Catheter ablation

LONG QT

Bidirectional VT

T-dP

Rx that cause Brugada ECG

Rx algorithm in Brugada

Brugada vs. EPRS

NSVTNormal heart+NSVT=Rx to ↓ S/S/LVDNSVT burden ≥ 15%-20% of Holter=

Drug+RFAOld MI+NSVT=

1.EF≥40% -only symptomatic 2.EF=30-40% then EPS-then ICD 3.EF<30%-ICD

Success lies in detachment