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Dr. Mete ALPASLAN
Ventricular Tachycardia (VT)
Diagnostic criteria
Wide QRS complex tachycardia including at least 3 consecutive VPCs at a rate >100/minute
Since impulses originate from ventricles, there are no P waves preceed QRS complexes.
Since atria and ventricles contract independently, atrial rate is less than ventricular rate during a ventricular tachycardia (AV dissociation). This results in infrequent atrial activity whose rate is less than ventricular rate. AV dissociation favors the diagnosis of ventricular tachycardia, but it is seen only in 20-50% of VT attacks.
In patients with preexisting bundle branch block, development of supraventricular tachycardia may resemble ventricular tachycardia at first glance.
Monomorphic ventricular tachycardia (VT) is the most common electrical storm-documented arrhythmia.
Click here to go to right ventricular outflow tract (RVOT) VTs.
ECG 1. VT run. The presence of 3 or more VPCs at a speed of at least 100/minute is enough for the diagnosis.
Click here for a more detailed ECG
ECG 2. Ventricular tachycardia. The infrequent P waves show atrioventricular dissociation.
Click here for a more detailed ECG
ECG 3a. Attacks of ventricular tachycardia in a coronary artery disease patient with severe left ventricular dysfunction.
The 3 QRS complexes in-between are of supraventricular origin.
Click here for a more detailed ECG
ECG 3b. The ECG of the same patient on another day shows VT attack in leads II, C4, C5 and C6.
The P wave activity due to atrioventricular dissociation supports the diagnosis of VT.
Click here for a more detailed ECG
ECG 4a. VT attack is seen in the above ECG from a coronary artery diasease patient with left ventricular systolic dysfunction.
Positive concordance (positive QRS complexes in all chest leads) usually suggest the diagnosis of VT.
Click here for a more detailed ECG
ECG 4b. The ECG above belongs to the same patient and was recorded after successful electrical cardioversion.
ECG evidence of old inferior wall myocardial infarction is seen.
Click here for a more detailed ECG
ECG 5. Capture beat during a VT attack is seen in the above ECG.
Capture beats with narrow QRS complexes show that the wide QRS complex rhythm is of ventricular origin.
Intermittent appearance of P waves among the wide QRS complex tachycardia is a sign of atrioventricular
dissociation and supports the diagnosis of VT.
Prof. Dr. Bulent Özin has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 6. Polymorphic VT attack is seen in the above Holter recording. VPC shapes of the VT show differ.
This is not a monomorphic VT.
It is not catecholaminergic polymorphic VT (CPVT) since it appeared while asleep.
Click here for a more detailed ECG
ECG 7a. The 3-channel rhythm tracing above is from the Holter recording of a 77 years-old woman with hypertension and
coronary artery disease.
Non-sustained irregular VT attack is seen. The longest interectopic intervals are the last two: 480 ms.
Click here for a more detailed ECG
ECG 7b. The Holter recording above is from the same patient.
Three hours later, non-sustained and irregular monomorphic VT attacks are seen.
In both attacks the last interectopic interval is also the longest one.
Click here for a more detailed ECG
ECG 8. The 3-channel rhythm tracing above is from the Holter recording of a 45 years-old woman with no structural heart disease.
Two irregular non-sustained monomorphic VT attacks are seen.
In both attacks the last interectopic interval is also the longest one.
Also, atrial activity shows atrioventricular dissociation.
Click here for a more detailed ECG
ECG 9. The ECG above was recorded during the treadmill exercise test of a middle-aged woman.
Irregular and non-sustained VT attack of 4 beats is seen (tachycardic wide QRS rhythm lacking preceding P waves),
The frst interectopic interval is also the longest one.
Click here for a more detailed ECG
ECG 10a. Above is the 3-channel Holter rhythm tracing of a middle-aged woman.
Short coupling intervals result in VPCs on T waves (R on T)
Click here for a more detailed ECG
ECG 10b. Another tracing from the Holter recording of the same patient is seen above.
The initial beat of VT is morphologically different from the other ectopic beats.
This nonsustained VT has an onset similar to Anderson classification Type 1.
Click here for a more detailed ECG
ECG 10c. Another tracing from the Holter recording of the same patient is seen above.
The initial beat of VT is morphologically different from the other ectopic beats.
This nonsustained VT has an onset similar to Anderson classification Type 1.
The coupling interval of the first VPC ( 385 ms ) is shorter than that of the first interectopic interval ( 635 ms ).
Click here for a more detailed ECG
ECG 11a. The ECG above is from a 74 years-old man who had undergone previous coronary artery bypass graft surgery.
Monomorphic ventricular tachycardia attack is seen.
The computer of the ECG machine failed to diagnose the VT in the above ECG.
Cardiologist Dr. Cegergun Polat has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 11b. The ECG above is from a 74 years-old man who had undergone previous coronary artery byppass graft surgery.
Fusion beat shows that this wide QRS complex tachycardia is of ventricular origin.
The fusion beat in lead aVR looks very similar to the VT beats at the same lead.
The computer of the ECG machine again failed to diagnose the VT in the above ECG.
Cardiologist Dr. Cegergun Polat has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 11c. Above is his ECG which was recorded after termination of the VT attack by medical therapy.
Cardiologist Dr. Cegergun Polat has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 12a. The ECG above belongs to a 48 years-old man. He had undergone Bentall operation 5 days ago.
Wide-QRS tachycardia in the form of left bundle branch block is seen.
No capture beat, no fusion beat, no atrioventricular (AV) dissociation.
Is the rhythm ventricular tachycardia (VT ?)
Dr. Erkan Kısacık has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 12b. The ECG above belongs to the same patient. It was recorded after electrical cardioversion with 50 Joules.
Now, the rhythm is sinus. Left bundle branch block is also seen.
Later on, electrophysiologic study (EPS) revealed atrial flutter with 1:1 conduction.
The ECG 22a was actually atrial flutter with a 1:1 conduction to the ventricles.
Every wide QRS tachycardia is not necessarily a VT.
Dr. Sinan Altan Kocaman has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 13a. The above ECG is from a man with left heart failure due to dilated cardiomyopathy.
He has normal coronary arteries. He also has a permanent cardiac pacemaker (ICD).
Paced-beat, VPC and non-sustained monomorphic ventricular tachycardia attacks are seen.
Click here for a more detailed ECG
ECG 13b. The ECG above belongs to the same man.
VPCs and non-sustained monomorphic ventricular tachycardia attack are seen.
Click here for a more detailed ECG
ECG 13c. The ECG above belongs to the same man.
Ventricular tachycardia with QRS alternans is seen.
Click here for a more detailed ECG
ECG 14. The rhythm on the left side of the above ECG is ventricular tachycardia (VT).
The patient had undergone permanent cardiac pacemaker implantation in the past.
During the VT, the pacemaker intervenes with AntiTachycardia Pacing (ATP).
The first pacemaker impulse results in a Fusion beat.
The following 4 pacemaker stimuli converts VT to the sinus rhythm.
Dr Wayne Whitwam has donated the above ECG to our website.
Click here for a more detailed ECG
Wide QRS complex tachycardia including at least 3 consecutive VPCs at a rate >100/minute
Since impulses originate from ventricles, there are no P waves preceed QRS complexes.
Since atria and ventricles contract independently, atrial rate is less than ventricular rate during a ventricular tachycardia (AV dissociation). This results in infrequent atrial activity whose rate is less than ventricular rate. AV dissociation favors the diagnosis of ventricular tachycardia, but it is seen only in 20-50% of VT attacks.
In patients with preexisting bundle branch block, development of supraventricular tachycardia may resemble ventricular tachycardia at first glance.
Monomorphic ventricular tachycardia (VT) is the most common electrical storm-documented arrhythmia.
Click here to go to right ventricular outflow tract (RVOT) VTs.
ECG 1. VT run. The presence of 3 or more VPCs at a speed of at least 100/minute is enough for the diagnosis.
Click here for a more detailed ECG
ECG 2. Ventricular tachycardia. The infrequent P waves show atrioventricular dissociation.
Click here for a more detailed ECG
ECG 3a. Attacks of ventricular tachycardia in a coronary artery disease patient with severe left ventricular dysfunction.
The 3 QRS complexes in-between are of supraventricular origin.
Click here for a more detailed ECG
ECG 3b. The ECG of the same patient on another day shows VT attack in leads II, C4, C5 and C6.
The P wave activity due to atrioventricular dissociation supports the diagnosis of VT.
Click here for a more detailed ECG
ECG 4a. VT attack is seen in the above ECG from a coronary artery diasease patient with left ventricular systolic dysfunction.
Positive concordance (positive QRS complexes in all chest leads) usually suggest the diagnosis of VT.
Click here for a more detailed ECG
ECG 4b. The ECG above belongs to the same patient and was recorded after successful electrical cardioversion.
ECG evidence of old inferior wall myocardial infarction is seen.
Click here for a more detailed ECG
ECG 5. Capture beat during a VT attack is seen in the above ECG.
Capture beats with narrow QRS complexes show that the wide QRS complex rhythm is of ventricular origin.
Intermittent appearance of P waves among the wide QRS complex tachycardia is a sign of atrioventricular
dissociation and supports the diagnosis of VT.
Prof. Dr. Bulent Özin has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 6. Polymorphic VT attack is seen in the above Holter recording. VPC shapes of the VT show differ.
This is not a monomorphic VT.
It is not catecholaminergic polymorphic VT (CPVT) since it appeared while asleep.
Click here for a more detailed ECG
ECG 7a. The 3-channel rhythm tracing above is from the Holter recording of a 77 years-old woman with hypertension and
coronary artery disease.
Non-sustained irregular VT attack is seen. The longest interectopic intervals are the last two: 480 ms.
Click here for a more detailed ECG
ECG 7b. The Holter recording above is from the same patient.
Three hours later, non-sustained and irregular monomorphic VT attacks are seen.
In both attacks the last interectopic interval is also the longest one.
Click here for a more detailed ECG
ECG 8. The 3-channel rhythm tracing above is from the Holter recording of a 45 years-old woman with no structural heart disease.
Two irregular non-sustained monomorphic VT attacks are seen.
In both attacks the last interectopic interval is also the longest one.
Also, atrial activity shows atrioventricular dissociation.
Click here for a more detailed ECG
ECG 9. The ECG above was recorded during the treadmill exercise test of a middle-aged woman.
Irregular and non-sustained VT attack of 4 beats is seen (tachycardic wide QRS rhythm lacking preceding P waves),
The frst interectopic interval is also the longest one.
Click here for a more detailed ECG
ECG 10a. Above is the 3-channel Holter rhythm tracing of a middle-aged woman.
Short coupling intervals result in VPCs on T waves (R on T)
Click here for a more detailed ECG
ECG 10b. Another tracing from the Holter recording of the same patient is seen above.
The initial beat of VT is morphologically different from the other ectopic beats.
This nonsustained VT has an onset similar to Anderson classification Type 1.
Click here for a more detailed ECG
ECG 10c. Another tracing from the Holter recording of the same patient is seen above.
The initial beat of VT is morphologically different from the other ectopic beats.
This nonsustained VT has an onset similar to Anderson classification Type 1.
The coupling interval of the first VPC ( 385 ms ) is shorter than that of the first interectopic interval ( 635 ms ).
Click here for a more detailed ECG
ECG 11a. The ECG above is from a 74 years-old man who had undergone previous coronary artery bypass graft surgery.
Monomorphic ventricular tachycardia attack is seen.
The computer of the ECG machine failed to diagnose the VT in the above ECG.
Cardiologist Dr. Cegergun Polat has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 11b. The ECG above is from a 74 years-old man who had undergone previous coronary artery byppass graft surgery.
Fusion beat shows that this wide QRS complex tachycardia is of ventricular origin.
The fusion beat in lead aVR looks very similar to the VT beats at the same lead.
The computer of the ECG machine again failed to diagnose the VT in the above ECG.
Cardiologist Dr. Cegergun Polat has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 11c. Above is his ECG which was recorded after termination of the VT attack by medical therapy.
Cardiologist Dr. Cegergun Polat has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 12a. The ECG above belongs to a 48 years-old man. He had undergone Bentall operation 5 days ago.
Wide-QRS tachycardia in the form of left bundle branch block is seen.
No capture beat, no fusion beat, no atrioventricular (AV) dissociation.
Is the rhythm ventricular tachycardia (VT ?)
Dr. Erkan Kısacık has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 12b. The ECG above belongs to the same patient. It was recorded after electrical cardioversion with 50 Joules.
Now, the rhythm is sinus. Left bundle branch block is also seen.
Later on, electrophysiologic study (EPS) revealed atrial flutter with 1:1 conduction.
The ECG 22a was actually atrial flutter with a 1:1 conduction to the ventricles.
Every wide QRS tachycardia is not necessarily a VT.
Dr. Sinan Altan Kocaman has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 13a. The above ECG is from a man with left heart failure due to dilated cardiomyopathy.
He has normal coronary arteries. He also has a permanent cardiac pacemaker (ICD).
Paced-beat, VPC and non-sustained monomorphic ventricular tachycardia attacks are seen.
Click here for a more detailed ECG
ECG 13b. The ECG above belongs to the same man.
VPCs and non-sustained monomorphic ventricular tachycardia attack are seen.
Click here for a more detailed ECG
ECG 13c. The ECG above belongs to the same man.
Ventricular tachycardia with QRS alternans is seen.
Click here for a more detailed ECG
ECG 14. The rhythm on the left side of the above ECG is ventricular tachycardia (VT).
The patient had undergone permanent cardiac pacemaker implantation in the past.
During the VT, the pacemaker intervenes with AntiTachycardia Pacing (ATP).
The first pacemaker impulse results in a Fusion beat.
The following 4 pacemaker stimuli converts VT to the sinus rhythm.
Dr Wayne Whitwam has donated the above ECG to our website.
Click here for a more detailed ECG