Ventricular arrhythmia

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Ventricular arrhythmias are potentially very dangerous cardiacarrhythmias arising from the cardiac ventricles that require immediate attention and medical care and include the following rhytmsrhythms:

  • premature ventricular complexes
  • ventricular tachycardia
  • torsades de pointes
  • ventricular flutter and/or
  • ventricular fibrillation

Ventricular tachyarrhytmiastachyarrhythmias are those ventricular arrhytmiasarrhythmias associated with an increased hearheart rate.

Epidemiology

The frequency of premature ventricular complexes is common and increases with age. Ventricular tachyarrythmias are commonly associated with isachaemicischaemic and structural heart disease 1,2.

Associations

Ventricular arrhythmias are associated with the following conditions 1-3:

Diagnosis

The diagnosis of ventricular arrhythmias is made on an electrocardiogram and can be classified into the following 2-6:

  • premature ventricular complexes
  • ventricular tachycardia: wide QRS complexes (QRS ≥120 ms)
    • three or more consecutive beats with a heart rate of ≥100 bpm
    • sustained: >30s;30 sec or with haemodynamic compromise
    • non-sustained: ≥3 beats with spontaneous termination
    • monomorphic ventricular tachycardia: stable QRS morphology
    • polymorphic ventricular tachycardia: multiform or alternating QRS morphology
    • bidirectional ventricular tachicardia
  • torsades de pointes:
    • polymorphic ventricular tachycardia with long QT interval
    • waxing and waning QRS amplitude
  • ventricular flutter: regular high heart rate ~250-300 bpm with a sinusoidal monomorphic appearance
  • ventricular fibrillation: grossly irregular ventricular activity

Clinical presentation

Symptoms include fatigue, lightheadedness, dizziness, palpitations, presyncope, syncope and chest pain, dyspnoea 1-3.

Complications

Complications of atrioventricular blockventricular arrhythmias include 2,3:

Pathology

Mechanisms responsible for ventricular tachycardia include abnormal and/or increased automaticity, triggered activity and reentry 2-4.

Aetiology

Aetiologies of ventricular tachycardia include 2,3:

Treatment and prognosis

Management of ventricular arrhytmiasarrhythmias depend on acute symptoms and the type of arrhytmiaarrhythmia and include treatment of the underlying conditions and comorbidities, appropriate pharmacotherapy, device therapy and interventional therapy 2,3.

Pharmacotherapy involves antiarrhytmicantiarrhythmic drugs such as beta-blockers, amaiodaroneamiodarone, solatol and combination therapy 2,3. Device therapy includes implantation of an implanatableimplantable cardioverter defibrillatodefibrillator and interventional therapy includes catheter ablation and anti-arrhythmic surgery 2,3.

Acute treatment of haemodynamically unstable patients includes cardioversion in case of or defibrillation depending on the the respective ventricular arrhytmiaarrhythmia according to advanced cardiac life support guidelines 2,3.

Differential diagnosis

DifferentialThe differential diagnosis includeincludes supraventricular tachycardia with or without bundle branch block 5.

  • -<p><strong>Ventricular arrhythmias </strong>are potentially very dangerous cardiac<strong> </strong>arrhythmias arising from the cardiac ventricles that require immediate attention and medical care and include the following rhytms:</p><p>premature ventricular complexes</p><p>ventricular tachycardia</p><p>torsades de pointes</p><p>ventricular flutter and/or fibrillation</p><p><strong>Ventricular tachyarrhytmias</strong> are those ventricular arrhytmias associated with an increased hear rate.</p><h4>Epidemiology</h4><p>The frequency of premature ventricular complexes is common and increases with age. Ventricular tachyarrythmias are commonly associated with isachaemic and structural heart disease <sup>1,2</sup>.</p><h5>Associations</h5><p>Ventricular arrhythmias are associated with the following conditions <sup>1-3</sup>:</p><p>ischaemic heart disease</p><p>structural heart disease</p><p>cardiac arrest</p><p>sudden cardiac death</p><h4>Diagnosis</h4><p>The diagnosis of ventricular arrhythmias is made on electrocardiogram and can be classified into the following <sup>2-6</sup>:</p><p> </p><p>premature ventricular complexes</p><p>ventricular tachycardia: wide QRS complexes (QRS ≥120 ms)</p><p>three or more consecutive beats with a heart rate of ≥100 bpm</p><p>sustained: &gt;30s or with haemodynamic compromise</p><p>non-sustained: ≥3 beats with spontaneous termination</p><p>monomorphic ventricular tachycardia: stable QRS morphology</p><p>polymorphic ventricular tachycardia: multiform or alternating QRS morphology</p><p>bidirectional ventricular tachicardia</p><p>torsades de pointes:</p><p>polymorphic ventricular tachycardia with long QT interval</p><p>waxing and waning QRS amplitude</p><p>ventricular flutter: regular high heart rate ~250-300 bpm with sinusoidal monomorphic appearance</p><p>ventricular fibrillation: grossly irregular ventricular activity</p><h4>Clinical presentation</h4><p>Symptoms include fatigue, lightheadedness, dizziness, palpitations, presyncope, syncope and chest pain, dyspnoea <sup>1-3</sup>.</p><p> </p><h5>Complications</h5><p>Complications of atrioventricular block include <sup>2,3</sup>:</p><p>heart failure</p><p>cardiac arrest</p><p>sudden cardiac death</p><h4>Pathology</h4><p>Mechanisms responsible for ventricular tachycardia include abnormal and/or increased automaticity, triggered activity and reentry <sup>2-4</sup>.</p><h5>Aetiology</h5><p>Aetiologies of ventricular tachycardia include <sup>2,3</sup>:</p><p>myocardial ischaemia/myocardial infarction</p><p>structural heart disease</p><p>cardiomyopathies</p><p>hypertrophic cardiomyopathy</p><p>arrhytmogenic ventricular cardiomyopathy</p><p>infiltrative cardiomyopathies</p><p>left ventricular non-compaction</p><p>channelopathies</p><p>long QT syndrome</p><p>short QT syndrome</p><p>Brugada syndrome</p><p>catecholaminergic polymoprhic ventricular tachycardia</p><p>drug toxicity</p><p>metabolic disorders (hypokalaemia, hypomagnesaemia, hypocalcaemia)</p><p>idiopathic</p><h4>Treatment and prognosis</h4><p>Management of ventricular arrhytmias depend on acute symptoms and the type of arrhytmia and include treatment of the underlying conditions and comorbidities, appropriate pharmacotherapy, device therapy and interventional therapy <sup>2,3</sup>.</p><p>Pharmacotherapy involves antiarrhytmic drugs such as beta-blockers, amaiodarone, solatol and combination therapy <sup>2,3</sup>. Device therapy includes implantation of an implanatable cardioverter defibrillato and interventional therapy includes catheter ablation and anti-arrhythmic surgery <sup>2,3</sup>.</p><p> </p><p>Acute treatment of haemodynamically unstable patients includes cardioversion in case of or defibrillation depending on the the respective ventricular arrhytmia according to advanced cardiac life support guidelines <sup>2,3</sup>.</p><p> </p><h4>Differential diagnosis</h4><p>Differential diagnosis include supraventricular tachycardia with or without bundle branch block <sup>5</sup>.</p>
  • +<p><strong>Ventricular arrhythmias </strong>are potentially very dangerous cardiac<strong> </strong>arrhythmias arising from the cardiac ventricles that require immediate attention and medical care and include the following rhythms:</p><ul>
  • +<li>premature ventricular complexes</li>
  • +<li>ventricular tachycardia</li>
  • +<li>torsades de pointes</li>
  • +<li>ventricular flutter</li>
  • +<li><a href="/articles/ventricular-fibrillation">ventricular fibrillation</a></li>
  • +</ul><p><strong>Ventricular tachyarrhythmias</strong> are those ventricular arrhythmias associated with an increased heart rate.</p><h4>Epidemiology</h4><p>The frequency of premature ventricular complexes is common and increases with age. Ventricular tachyarrythmias are commonly associated with ischaemic and structural heart disease <sup>1,2</sup>.</p><h5>Associations</h5><p>Ventricular arrhythmias are associated with the following conditions <sup>1-3</sup>:</p><ul>
  • +<li><a href="/articles/myocardial-ischaemia">ischaemic heart disease</a></li>
  • +<li><a href="/articles/structural-heart-disease">structural heart disease</a></li>
  • +<li><a href="/articles/cardiac-arrest">cardiac arrest</a></li>
  • +<li><a href="/articles/sudden-cardiac-death">sudden cardiac death</a></li>
  • +</ul><h4>Diagnosis</h4><p>The diagnosis of ventricular arrhythmias is made on an electrocardiogram and can be classified into the following <sup>2-6</sup>:</p><ul>
  • +<li>premature ventricular complexes</li>
  • +<li>ventricular tachycardia: wide QRS complexes (QRS ≥120 ms)<ul>
  • +<li>three or more consecutive beats with a heart rate of ≥100 bpm</li>
  • +<li>sustained: &gt;30 sec or with haemodynamic compromise</li>
  • +<li>non-sustained: ≥3 beats with spontaneous termination</li>
  • +<li>monomorphic ventricular tachycardia: stable QRS morphology</li>
  • +<li>polymorphic ventricular tachycardia: multiform or alternating QRS morphology</li>
  • +<li>bidirectional ventricular tachicardia</li>
  • +</ul>
  • +</li>
  • +<li>torsades de pointes:<ul>
  • +<li>polymorphic ventricular tachycardia with long QT interval</li>
  • +<li>waxing and waning QRS amplitude</li>
  • +</ul>
  • +</li>
  • +<li>ventricular flutter: regular high heart rate ~250-300 bpm with a sinusoidal monomorphic appearance</li>
  • +<li>
  • +<a title="Ventricular fibrillation" href="/articles/ventricular-fibrillation">ventricular fibrillation</a>: grossly irregular ventricular activity</li>
  • +</ul><h4>Clinical presentation</h4><p>Symptoms include fatigue, lightheadedness, dizziness, palpitations, presyncope, syncope and chest pain, dyspnoea <sup>1-3</sup>.</p><h5>Complications</h5><p>Complications of ventricular arrhythmias include <sup>2,3</sup>:</p><ul>
  • +<li><a href="/articles/congestive-cardiac-failure">heart failure</a></li>
  • +<li>cardiac arrest</li>
  • +<li>sudden cardiac death</li>
  • +</ul><h4>Pathology</h4><p>Mechanisms responsible for ventricular tachycardia include abnormal and/or increased automaticity, triggered activity and reentry <sup>2-4</sup>.</p><h5>Aetiology</h5><p>Aetiologies of ventricular tachycardia include <sup>2,3</sup>:</p><ul>
  • +<li>
  • +<a href="/articles/myocardial-ischaemia">myocardial ischaemia</a>/<a href="/articles/myocardial-infarction">myocardial infarction</a>
  • +</li>
  • +<li><a href="/articles/valvular-heart-disease">valvular heart disease</a></li>
  • +<li>
  • +<a href="/articles/cardiomyopathy-1">cardiomyopathies</a><ul>
  • +<li><a href="/articles/hypertrophic-cardiomyopathy">hypertrophic cardiomyopathy</a></li>
  • +<li><a href="/articles/arrhythmogenic-right-ventricular-cardiomyopathy">arrhythmogenic right ventricular cardiomyopathy</a></li>
  • +<li><a href="/articles/infiltrative-cardiomyopathy">infiltrative cardiomyopathies</a></li>
  • +<li><a href="/articles/non-compaction-of-the-left-ventricle-1">left ventricular non-compaction</a></li>
  • +</ul>
  • +</li>
  • +<li>channelopathies<ul>
  • +<li>long QT syndrome</li>
  • +<li>short QT syndrome</li>
  • +<li>Brugada syndrome</li>
  • +<li>catecholaminergic polymorphic ventricular tachycardia</li>
  • +</ul>
  • +</li>
  • +<li>drug toxicity</li>
  • +<li>metabolic disorders (hypokalaemia, hypomagnesaemia, hypocalcaemia)</li>
  • +<li>idiopathic</li>
  • +</ul><h4>Treatment and prognosis</h4><p>Management of ventricular arrhythmias depend on acute symptoms and the type of arrhythmia and include treatment of the underlying conditions and comorbidities, appropriate pharmacotherapy, device therapy and interventional therapy <sup>2,3</sup>.</p><p>Pharmacotherapy involves antiarrhythmic drugs such as beta-blockers, amiodarone, solatol and combination therapy <sup>2,3</sup>. Device therapy includes implantation of an <a href="/articles/cardiac-conduction-devices">implantable cardioverter defibrillator</a> and interventional therapy includes catheter ablation and anti-arrhythmic surgery <sup>2,3</sup>.</p><p>Acute treatment of haemodynamically unstable patients includes cardioversion in case of or defibrillation depending on the respective ventricular arrhythmia according to advanced cardiac life support guidelines <sup>2,3</sup>.</p><h4>Differential diagnosis</h4><p>The differential diagnosis includes supraventricular tachycardia with or without bundle branch block <sup>5</sup>.</p>

References changed:

  • 1. Sirichand S, Killu A, Padmanabhan D et al. Incidence of Idiopathic Ventricular Arrhythmias. Circ: Arrhythmia and Electrophysiology. 2017;10(2). <a href="https://doi.org/10.1161/circep.116.004662">doi:10.1161/circep.116.004662</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28183845">Pubmed</a>
  • 2. Al-Khatib S, Stevenson W, Ackerman M et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Circulation. 2018;138(13):e272-391. <a href="https://doi.org/10.1161/cir.0000000000000549">doi:10.1161/cir.0000000000000549</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29084731">Pubmed</a>
  • 3. Priori S, Blomström-Lundqvist C, Mazzanti A et al. 2015 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed By: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793-867. <a href="https://doi.org/10.1093/eurheartj/ehv316">doi:10.1093/eurheartj/ehv316</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26320108">Pubmed</a>
  • 4. Edhouse J & Morris F. Broad Complex Tachycardia--Part I. BMJ. 2002;324(7339):719-22. <a href="https://doi.org/10.1136/bmj.324.7339.719">doi:10.1136/bmj.324.7339.719</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11909791">Pubmed</a>
  • 5. Edhouse J & Morris F. ABC of Clinical Electrocardiography: Broad Complex Tachycardia-Part II. BMJ. 2002;324(7340):776-9. <a href="https://doi.org/10.1136/bmj.324.7340.776">doi:10.1136/bmj.324.7340.776</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11923163">Pubmed</a>
  • 6. Dale Dubin. Rapid Interpretation of EKG's. (2000) ISBN: 9780912912066 - <a href="http://books.google.com/books?vid=ISBN9780912912066">Google Books</a>

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