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| ==Overview== | | ==Overview== |
| [[Ventricular tachycardia]] refers to a [[rhythm]] with a [[heart rate]] in excess of 100 (and in some definitions 120) beats per minute that arises distal to the [[bundle of His]]. [[Ventricular tachycardia]] can be classified based on three main categories. Firstly, The morphology of the [[QRS complexes]] on the [[ECG]] ([[monomorphic ventricular tachycardia]] vs [[polymorphic ventricular tachycardia]]). Secondly, The duration of the episode. Thirdly, The symptoms associated with the episode. | | [[Ventricular tachycardia]] refers to a [[rhythm]] with a [[heart rate]] in excess of 100 (and in some definitions 120) beats per minute that arises distal to the [[bundle of His]]. [[Ventricular tachycardia]] can be classified based on three main categories. Firstly, The [[morphology]] of the [[QRS complexes]] on the [[ECG]] ([[monomorphic ventricular tachycardia]] vs [[polymorphic ventricular tachycardia]]). Secondly, The duration of the episode. Thirdly, The symptoms associated with the episode. |
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| ==Classification Based Upon Morphology of the QRS Complexes== | | ==Classification Based Upon Morphology of the QRS Complexes== |
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| * The heart usually tolerates this rhythm poorly in the medium to long term, and patients may certainly deteriorate to [[pulseless VT]] or to [[VF]]. | | * The heart usually tolerates this rhythm poorly in the medium to long term, and patients may certainly deteriorate to [[pulseless VT]] or to [[VF]]. |
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| ==2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Sustained Monomorphic Ventricular Tachycardia (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Wide-QRS tachycardia should be presumed to be VT if the diagnosis is unclear. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Direct-current [[cardioversion]] with appropriate [[sedation]] is recommended at any point in the treatment cascade in patients with suspected sustained monomorphic VT with [[hemodynamic compromise]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |}
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| {|class="wikitable"
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| |colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
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| |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Calcium channel blockers]] such as [[verapamil]] and [[diltiazem]] should not be used in patients to terminate wide-QRS-complex tachycardia of unknown origin, especially in patients with a history of myocardial dysfunction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |}
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[procainamide]] (or ajmaline in some European countries) is reasonable for initial treatment of patients with stable sustained monomorphic VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Intravenous [[amiodarone]] is reasonable for patients with sustained monomorphic VT that is [[hemodynamically unstable]], refractory to conversion with countershock, or recurrent despite [[procainamide]] or other agents. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Transvenous catheter pace termination can be useful to treat patients with sustained monomorphic VT that is refractory to [[cardioversion]] or is frequently recurrent despite [[antiarrhythmic]] medication. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIb]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[lidocaine]] might be reasonable for initial treatment of patients with stable sustained monomorphic VT specifically associated with acute [[myocardial ischemia]] or [[acute myocardial infarction|infarction]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| ==2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Polymorphic Ventricular Tachycardia (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Direct current [[cardioversion]] with appropriate sedation as necessary is recommended for patients with sustained polymorphic VT with [[hemodynamic compromise]] and is reasonable at any point in the treatment cascade. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Intravenous [[beta blockers]] are useful for patients with recurrent polymorphic VT especially if [[ischemia]] is suspected or cannot be excluded. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Intravenous loading with [[amiodarone]] is useful for patients with recurrent polymorphic VT in the absence of abnormal repolarization related to congenital or acquired [[LQTS]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Urgent [[angiography]] with a view to [[revascularization]] should be considered for patients with polymorphic VT when [[myocardial ischemia]] cannot be excluded. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| {|class="wikitable"
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| |-
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIb]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[lidocaine]] may be reasonable for treatment of polymorphic VT specifically associated with [[acute myocardial ischemia]] or [[acute myocardial infarction|infarction]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| ==2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Repetitive Monomorphic Ventricular Tachycardia (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[amiodarone]], [[beta blockers]], and intravenous [[procainamide]] (or [[sotalol]] or [[ajmaline]] in Europe) can be useful for treating repetitive monomorphic VT in the context of [[coronary disease]] and idiopathic VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| ==2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Incessant Ventricular Tachycardia (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Revascularization]] and [[beta blockade]] followed by intravenous [[antiarrhythmic drugs]] such as [[procainamide]] or [[amiodarone]] are recommended for patients with recurrent or incessant polymorphic VT due to [[acute myocardial ischemia]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |}
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| {|class="wikitable"
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| |-
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[amiodarone]] or [[procainamide]] followed by VT [[ablation]] can be effective in the management of patients with frequently recurring or incessant monomorphic VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIb]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[amiodarone]] and intravenous [[beta blockers]] separately or together may be reasonable in patients with VT storm. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Overdrive pacing or [[general anesthesia]] may be considered for patients with frequently recurring or incessant VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[Spinal cord]] modulation may be considered for some patients with frequently recurring or incessant VT. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| |}
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| ==References== | | ==References== |
