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
Monomorphic VT
  • Uniform and stable beat to beat QRS morphology
  • 12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)
    12 lead electrocardiogram showing a run of monomorphic ventricular tachycardia (VT)
Polymorphic VT
  • Changing beat to beat QRS morphology
  • Adopted from Wikipedia
Bidirectional VT
Torsades de pointes
Ventricular flutter
Ventricular fibrillation


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

12 lead electrocardiogram-Rhythm- ventricular-fibrillation (VF)
12 lead electrocardiogram-Rhythm- ventricular-fibrillation (VF)


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

Polymorphic ventricular tachycardia

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

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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