ventricular tachycardia

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Dr Ramachandra Ventricular Tachycardia 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.”

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DESCRIPTION

Ventricular tachycardia (VT) is a broad complex tachycardia originating from a ventricular ectopic focus. It is defined as three or more ventricular extrasystoles in succession at a rate of more than 120 beats per minute (bpm). Accelerated idioventricular rhythm refers to ventricular rhythms with rates of 100-120 bpm

TRANSCRIPT

Page 1: 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

Page 2: Ventricular tachycardia

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

Page 3: Ventricular tachycardia

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

continuous QRS has no clear isoelectric baseline)

With or without hemodynamic collapse

Page 4: Ventricular tachycardia

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

aberrancy/AVRT/etc

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VT Cousins

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VT Cousins

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

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ECG

Page 9: Ventricular tachycardia

QRS in MI looks Spine or sternum?

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Poor R-wave progression and VT

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Where they came from?

Page 12: Ventricular tachycardia

Bundle branch reentry -VT

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Idiopathic Monomorphic VT

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Aortic cusp-VT

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Medical Rx of VT

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Amiodarone….Contid

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Major ICD trials

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Catheter ablation

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LONG QT

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Bidirectional VT

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T-dP

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Rx that cause Brugada ECG

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Rx algorithm in Brugada

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Brugada vs. EPRS

Page 25: Ventricular tachycardia

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

Page 26: Ventricular tachycardia

Success lies in detachment