Diagnostic criteria

  Wide QRS complex tachycardia including at least 3 consecutive VPCs at a rate >100/minute

  Since the impulse originates from the ventricles, there are no P waves preceding the QRS complexes.

  Since atria and ventricles contract independently, the atrial rate is less than ventricular rate during a

      ventricular tachycardia (
atrioventricular 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.




Electrical storm

  The presence of at least 3 attacks of VT or VF in less than 24 hours is usually called as "electrical storm".


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.

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ECG 2. Ventricular tachycardia.
The infrequent P waves show atrioventricular dissociation.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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