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Ventricular arrhythmias are potentially very dangerous cardiac arrhythmias arising from the cardiac ventricles that require immediate attention and medical care and include the following rhythms:
- premature ventricular complexes
- ventricular tachycardia
- torsades de pointes
- ventricular flutter
- ventricular fibrillation
Ventricular tachyarrhythmias are those ventricular arrhythmias associated with an increased heart rate.
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The frequency of premature ventricular complexes is common and increases with age. Ventricular tachyarrythmias are commonly associated with ischemic and structural heart disease 1,2.
Ventricular arrhythmias are associated with the following conditions 1-3:
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: >30 sec or with hemodynamic 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
Symptoms include fatigue, lightheadedness, dizziness, palpitations, presyncope, syncope and chest pain, dyspnea 1-3.
Complications of ventricular arrhythmias include 2,3:
- heart failure
- cardiac arrest
- sudden cardiac death
Mechanisms responsible for ventricular tachycardia include abnormal and/or increased automaticity, triggered activity and reentry 2-4.
Etiologies of ventricular tachycardia include 2,3:
- myocardial ischemia/myocardial infarction
- valvular heart disease
- long QT syndrome
- short QT syndrome
- Brugada syndrome
- catecholaminergic polymorphic ventricular tachycardia
- drug toxicity
- metabolic disorders (hypokalemia, hypomagnesemia, hypocalcemia)
Treatment and prognosis
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 2,3.
Pharmacotherapy involves antiarrhythmic drugs such as beta-blockers, amiodarone, solatol and combination therapy 2,3. Device therapy includes implantation of an implantable cardioverter defibrillator 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 respective ventricular arrhythmia according to advanced cardiac life support guidelines 2,3.
The differential diagnosis includes supraventricular tachycardia with or without bundle branch block 5.
- 1. Sirichand S, Killu A, Padmanabhan D et al. Incidence of Idiopathic Ventricular Arrhythmias. Circ: Arrhythmia and Electrophysiology. 2017;10(2). doi:10.1161/circep.116.004662 - Pubmed
- 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. doi:10.1161/cir.0000000000000549 - Pubmed
- 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. doi:10.1093/eurheartj/ehv316 - Pubmed
- 4. Edhouse J & Morris F. Broad Complex Tachycardia--Part I. BMJ. 2002;324(7339):719-22. doi:10.1136/bmj.324.7339.719 - Pubmed
- 5. Edhouse J & Morris F. ABC of Clinical Electrocardiography: Broad Complex Tachycardia-Part II. BMJ. 2002;324(7340):776-9. doi:10.1136/bmj.324.7340.776 - Pubmed
- 6. Dale Dubin. Rapid Interpretation of EKG's. (2000) ISBN: 9780912912066 - Google Books