Ventricular tachycardia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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.

Classification Based Upon Morphology of the QRS Complexes

Classification of ventriculat arrhythmia:

Term	Definition	Feature
Ventricular tachycardia	Presence of≥ 3 consecutive premature ventricular complexes with the rate of >100 beats per minute or cycle length< 600 ms
	Sustained VT	VT> 30 sec VT< 30 sec that needs to termination due to compromised hemodynamic
	Nonsustained, or unsustained VT	≥3 consecutive premature ventricular complexes, spontaneously termination
	Monomorphic VT	Uniform and stable beat to beat QRS morphology 12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)
	Polymorphic VT	Changing beat to beat QRS morphology Adopted from Wikipedia
	Bidirectional VT	VT with beat to beat changing QRS frontal plane axis, indicator of digoxin toxicity or catecholaminergic polymorphic VT
Torsades de pointes	A type of polymorphic VT Occurance in the setting of long QT interval Characterised by twisting of the points, waxing and waning QRS amplitude Long-short sequence with long-coupling interval to the first VT beat Maybe initiated after bradycardia such as high grade AV block
Ventricular flutter	A regular ventricular arrhythmia Rate about 300 beat per minute (bpm), or cycle length 200 ms Sinusoidal monophorphic QRS complexes Without any isoelecterical interval between successive QRS complexes
Ventricular fibrillation	Rapid, grossly irregular electrical activity Variation in morphologic waveforms Ventricular rate >300bpm, cycle length <200 ms

https://nl.ecgpedia.org/images/9/9e/Rhythm_ventricular_fibrillation.png https://nl.ecgpedia.org/images/thumb/9/9e/Rhythm_ventricular_fibrillation.png/120px-Rhythm_ventricular_fibrillation.png https://nl.ecgpedia.org/images/f/f6/Rhythm_flutter.png https://en.ecgpedia.org/index.php?title=Torsade_de_Pointes Based on the morphology of QRS complex ventricular tachycardia can be classified into the following subtypes:

Monomorphic ventricular tachycardia

• Monomorphic ventricular tachycardia is defined as a QRS complex morphology that is identical from beat-to-beat in all leads of the surface electrocardiogram (ECG).

12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)

Polymorphic ventricular tachycardia

• Polymorphic ventricular tachycardia is defined as QRS complexes with beat-to-beat variability in morphology.
• This most commonly appears as a cyclical progressive change in cardiac axis referred to by its french eponym torsade de pointes (literally translating to "twisting of the points").

Adopted from Wikipedia

Classification Based Upon Duration of Episode

Based upon duration of episode ventricular tachycardia can be classified into:

Non-sustained Ventricular Tachycardia or Paroxysmal Ventricular Tachycardia

• Rapid succession of three or more ectopic beats.
• Self terminates within 30 seconds.

Sustained Ventricular Tachycardia

• Lasts more than 30 seconds.

Incessant Ventricular Tachycardia

• The ventricular tachycardia is recurrent and the episodes are interrupted by only a few sinus beats.

Classification Based Upon Symptoms

Based upon symptoms ventricular tachycardia can be classified into:

Pulseless VT

• Pulseless VT is associated with no effective cardiac output, hence, no effective pulse, and is a cause of cardiac arrest.
• In this circumstance it is best treated the same way as ventricular fibrillation (VF) and is recognized as one of the shockable rhythms on the cardiac arrest protocol.

Perfusing Rhythm with VT

• Some VT is associated with reasonable cardiac output and may even be asymptomatic.
• The heart usually tolerates this rhythm poorly in the medium to long term, and patients may certainly deteriorate to pulseless VT or to VF.

References

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