Ventricular tachycardia electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]

Electrocardography(EKG)

Overview

The diagnosis of Ventricular tachycardia almost completely depends on EKG findings. The details are illustrated below. It is important to differentiate it from other wide complex tachycardias.

Electrocardiographic diagnostic findings

Ventricular tachycardia in Lead II (rhythm)
  1. Abnormal and wide QRS complexes with secondary ST segment and T wave changes.
    • Usual QRS duration is > 0.12 seconds, may be shorter if the ectopic focus is located in the ventricular septum.
    • The secondary ST segment and T wave changes are in a direction that is opposite the major deflection of the QRS.
    • A ventricular rate between 140 and 200 BPM.
    • When the rate is >200 and has a sine wave appearance, it is called ventricular flutter.
    • When the rate is <110 BPM it is called non-paroxysmal VT.
  2. A regular or slightly irregular (up to 0.03 seconds) rhythm.
  3. Abrupt onset and termination.
  4. AV dissociation.
    • Atrial rate slower than ventricular rate.
    • No relationship between atrial activity and ventricular activity.
    • There can be VA conduction.
      1. The RP interval is >0.11 seconds.
      2. Occurs in about 50% of cases.
      3. Uncommon when the ventricular rate is rapid (only 1/7 when the rate was>200).
  5. Capture beats.
    • Occurs when a supraventricular impulse is conducted and captures the ventricle.
    • They are rare.
  6. Fusion beats.

Examples of Ventricular Tachycardia:





References

  1. Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.
  2. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016
  3. Hammill S. C. Electrocardiographic diagnoses: Criteria and definitions of abnormalities, Chapter 18, MAYO Clinic, Concise Textbook of Cardiology, 3rd edition, 2007 ISBN 0-8493-9057-5

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