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Sustained ventricular tachycardias

Last reviewed: 8 Apr 2025
Last updated: 20 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • coronary artery disease
  • tachycardia
  • hypotension
Full details

Other diagnostic factors

  • weak pulse
  • syncope
  • presyncope
  • airway compromise
  • impaired consciousness
  • lightheadedness
  • dizziness
  • diminished responsiveness
  • chest discomfort
  • dyspnea
  • asymptomatic
Full details

Risk factors

  • coronary artery disease
  • acute myocardial infarction
  • left ventricular systolic dysfunction
  • hypertrophic cardiomyopathy
  • long QT syndrome
  • short QT syndrome
  • Brugada syndrome
  • sleep-disordered breathing (SDB)
  • family history of sudden death
  • mental or physical stress
  • ventricular pre-excitation
  • arrhythmogenic right ventricular cardiomyopathy
  • electrolyte imbalance
  • drug toxicity
  • Chagas disease and other cardiomyopathies
Full details

Diagnostic tests

1st tests to order

  • ECG
  • transthoracic echocardiogram
  • electrolytes
  • troponin I
Full details

Tests to consider

  • cardiac catheterization
  • cardiac MRI
  • electrophysiologic (EP) study
  • genetic testing
Full details

Treatment algorithm

INITIAL

hemodynamically unstable ventricular tachycardia with a pulse

torsades de pointes

catecholaminergic polymorphic ventricular tachycardia

ACUTE

hemodynamically stable nonidiopathic sustained ventricular tachycardia

hemodynamically stable idiopathic sustained ventricular tachycardia

ONGOING

nonidiopathic: at high risk for ventricular tachycardia or history of sustained ventricular tachycardia/cardiac arrest without identifiable reversible cause

idiopathic ventricular tachycardia

Contributors

Authors

Sei Iwai, MD, FACC, FHRS

Professor of Clinical Medicine

New York Medical College

Section Chief, Cardiac Electrophysiology

Westchester Medical Center Health Network

Valhalla

NY

Disclosures

SI is an author of some references cited in this topic.

Acknowledgements

Professor Sei Iwai would like to gratefully acknowledge Dr Kenneth Stein and Dr Richard Keating, previous contributors to this topic.

Disclosures

KS declares he is an employee of and shareholder in Boston Scientific, a manufacturer of implantable cardioverter defibrillators and ablation catheters. RK declares that he has no competing interests.

Peer reviewers

Suneet Mittal, MD

Director

Electrophysiology Laboratory

The St. Luke's-Roosevelt Hospital Center

New York

NY

Disclosures

SM declares that he has no competing interests.

Kenneth A. Ellenbogen, MD

Kontos Professor of Cardiology

Medical College of Virginia

Richmond

VA

Disclosures

KAE declares that he has no competing interests.

Kim Rajappan, MA, MD, MRCP

Consultant Cardiologist and Electrophysiologist

Cardiac Department

John Radcliffe Hospital

Oxford

UK

Disclosures

KR declares that she has no competing interests.

References

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Key articles

Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126.Full text  Abstract

Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline 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 on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018 Oct 2;72(14):e91-220. Abstract

Pedersen CT, Kay GN, Kalman J, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014 Oct;11(10):e166-96.Full text  Abstract

Panchal AR, Bartos JA, Cabañas JG, et al; Adult Basic and Advanced Life Support Writing Group. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-468.Full text  Abstract

Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Arrhythm. 2019 May 10;35(3):323-484.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Sustained ventricular tachycardias images
  • Differentials

    • Supraventricular tachycardia with aberrancy
    • Supraventricular tachycardia with preexcitation
    • Electrical artifact
    More Differentials
  • Guidelines

    • 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy
    • 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy
    More Guidelines
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