Sustained ventricular tachycardias

Last reviewed: 1 Mar 2023
Last updated: 20 Dec 2022



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
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • transthoracic echocardiogram
  • electrolytes
  • troponin I
More 1st investigations to order

Investigations to consider

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

Section Chief, Cardiac Electrophysiology

Westchester Medical Center Health Network




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


Professor 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

    • 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
    • 2020 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 3: adult basic and advanced life support
    More Guidelines
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