Sustained ventricular tachycardias

Last reviewed: 29 Oct 2022
Last updated: 18 Oct 2019



History and exam

Key diagnostic factors

  • coronary artery disease
  • tachycardia
  • hypotension
More key diagnostic factors

Other diagnostic factors

  • weak pulse
  • syncope
  • presyncope
  • airway compromise
  • impaired consciousness
  • lightheadedness
  • dizziness
  • diminished responsiveness
  • chest discomfort
  • dyspnea
  • asymptomatic
Other diagnostic factors

Risk factors

  • coronary artery disease
  • acute myocardial infarction
  • left ventricular systolic dysfunction
  • hypertrophic cardiomyopathy
  • long QT syndrome
  • short QT syndrome
  • Brugada syndrome
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • electrolytes
  • troponin I
  • creatine kinase-MB
More 1st investigations to order

Investigations to consider

  • transthoracic echocardiogram
  • cardiac catheterization
  • cardiac MRI
  • electrophysiologic study
  • genetic screening
More investigations to consider

Treatment algorithm


hemodynamically unstable ventricular tachycardia with a pulse

torsades de pointes

catecholaminergic polymorphic ventricular tachycardia


hemodynamically stable nonidiopathic sustained ventricular tachycardia

hemodynamically stable idiopathic sustained ventricular tachycardia


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

idiopathic ventricular tachycardia



Sei Iwai, MD, FACC, FHRS

Professor of Clinical Medicine

New York Medical College

Director, Cardiac Electrophysiology

Westchester Medical Center Health Network




SI is on the Biosense-Webster speakers' bureau. He receives honoraria from Biotronik, Boston Scientific, and Medtronic for lectures, and research grant support from Boston Scientific.


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


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


Electrophysiology Laboratory

The St. Luke's-Roosevelt Hospital Center

New York



SM declares that he has no competing interests.

Kenneth A. Ellenbogen, MD

Kontos Professor of Cardiology

Medical College of Virginia




KAE declares that he has no competing interests.

Kim Rajappan, MA, MD, MRCP

Consultant Cardiologist and Electrophysiologist

Cardiac Department

John Radcliffe Hospital




KR declares that she has no competing interests.

  • Sustained ventricular tachycardias images
  • Differentials

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

    • HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
    • American Heart Association web-based integrated guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 7: adult advanced cardiovascular life support
    More Guidelines
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