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Ventricular tachycardia

Last updated: April 19, 2021

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Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia originating in the cardiac ventricles. VT usually results from underlying cardiac diseases, such as myocardial infarction or cardiomyopathy, but it can also be idiopathic or caused by drugs and electrolyte imbalances. Clinical manifestations range from palpitations and syncope to cardiogenic shock and sudden cardiac death (SCD). The characteristic ECG findings of VT are wide QRS complexes (> 120 ms), tachycardia (≥ 100/minute), and signs of AV dissociation. In the acute setting, management of VT may require immediate cardioversion, defibrillation, or administration of antiarrhythmic drugs. Most patients who develop symptomatic, recurrent VT require long-term therapy involving antiarrhythmic medication, cardioverter-defibrillator implantation, or catheter ablation of the arrhythmogenic focus. Torsades de pointes (TdP) is a type of polymorphic VT occurring in patients with a prolonged QT interval. Intravenous magnesium sulfate and correction of the underlying etiology of prolonged QTc are important aspects of TdP management.

Ventricular fibrillation is a type of ventricular tachyarrhythmia but is covered in a separate article (see “Ventricular fibrillation”).

Reference: [3]

Cardiac causes [3][4]

Ischemic heart disease is the most common cause of ventricular tachycardia. [3]

Extracardiac causes [4]

Drug-induced toxicity and electrolyte abnormalities are the most common extracardiac causes of ventricular tachycardia.


VT can result from an alteration in myocardial automaticity, electrical conduction, or ventricular repolarization secondary to several factors (see “Etiology” for details).


  • Asynchronous atrial and ventricular beats and rapid ventricular rhythm → ↓ blood flow into the ventricle during diastole cardiac output
  • Consequent hemodynamic compromise → symptoms of syncope, MI, angina

Reference [3]

If sustained VT is suspected, immediately obtain an ECG to confirm the diagnosis and initiate treatment as it can rapidly progress to ventricular fibrillation and cause sudden cardiac death.

Reference: [3]

The management of ventricular fibrillation and pulseless VT is the same and includes CPR and defibrillation.

Avoid procainamide and sotalol in patients with prolonged QT interval as they risk conversion of VT to torsades de pointes. [3]

Reference [3]


ECG [3]

An ECG should be obtained in all patients with suspected VT (ongoing or resolved). In an unstable patient, a rhythm strip allows for rapid assessment and initiation of emergency measures. In all stable or stabilized patients, a 12-lead ECG is essential for a detailed evaluation.

Characteristic findings during VT

3 consecutive wide QRS complexes at a frequency ≥ 100/minute and signs of AV dissociation confirm a diagnosis of VT. [14]

In wide-complex tachycardia, signs of AV dissociation help distinguish between VT (AV dissociation present) from SVT with aberrancy (AV dissociation absent). See “Brugada criteria” for further information.

Findings during sinus rhythm

Laboratory studies [3]

Imaging [3]

  • Indications: all patients with confirmed VT to assess LVEF and evaluate for structural cardiac defects [15]
  • Modalities
  • Findings: Variable; may include valvular defects, regional wall motion abnormalities, ↓ LVEF, and evidence of myocardial infiltration, scarring, or inflammation.

Further assessment of suspected arrhythmia [3][15]

If there is any doubt regarding the diagnosis, assume VT rhythm and treat accordingly.

The differential diagnoses listed here are not exhaustive.

Approach [3]

Long-term management of patients with VT

Pharmacological therapy (antiarrhythmics) is often used alongside device therapy (e.g., ICD) to minimize symptoms, risk of recurrence, and risk of sudden cardiac death. Ablation of the arrhythmogenic foci is potentially curative.

Pharmacological therapy [3][15]

Medications to minimize VT recurrence [3][15]
Drug class Indications Medications
Safe in known heart disease β-blockers
Caution in known heart disease


(class III antiarrhythmic)

Class Ic antiarrhythmics
Calcium channel blockers

Implantable cardioverter-defibrillator (ICD) [3]

Ablation [3][19]

  • Overview
    • Potential curative treatment for VT
    • Most patients do not subsequently require an ICD or further antiarrhythmic therapy. [20][21]
    • Following an EP study, the arrhythmogenic focus is ablated.
  • Indications
    • Recurrent VT despite optimal therapy
    • Antiarrhythmics are not tolerated
    • Patient preference
  • Options

Torsades de pointes (TdP) [3][8]

We list the most important complications. The selection is not exhaustive.

Initial assessment

Hemodynamically unstable patients

Hemodynamically stable patients

Subsequent management

  1. Huizar JF, Ellenbogen KA, Tan AY, Kaszala K. Arrhythmia-Induced Cardiomyopathy. J Am Coll Cardiol. 2019; 73 (18): p.2328-2344. doi: 10.1016/j.jacc.2019.02.045 . | Open in Read by QxMD
  2. Neumar RW, Otto CW, Link MS, et al. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122 (18_suppl_3): p.S729-S767. doi: 10.1161/circulationaha.110.970988 . | Open in Read by QxMD
  3. 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. J Am Coll Cardiol. 2018; 72 (14): p.e91-e220. doi: 10.1016/j.jacc.2017.10.054 . | Open in Read by QxMD
  4. Patton KK. The Riddle of Nonsustained Ventricular Tachycardia and Sudden Cardiac Death. Circulation. 2010; 122 (5): p.449-451. doi: 10.1161/circulationaha.110.965244 . | Open in Read by QxMD
  5. Scirica BM, Braunwald E, Belardinelli L, et al. Relationship Between Nonsustained Ventricular Tachycardia After Non–ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death. Circulation. 2010; 122 (5): p.455-462. doi: 10.1161/circulationaha.110.937136 . | Open in Read by QxMD
  6. John RM, Tedrow UB, Koplan BA, et al. Ventricular arrhythmias and sudden cardiac death. Lancet. 2012; 380 (9852): p.1520-9. doi: 10.1016/S0140-6736(12)61413-5 . | Open in Read by QxMD
  7. Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013.. Heart rhythm. 2013; 10 (12): p.1932-63. doi: 10.1016/j.hrthm.2013.05.014 . | Open in Read by QxMD
  8. Fazio G, Vernuccio F, Grutta G, Re GL. Drugs to be avoided in patients with long QT syndrome: Focus on the anaesthesiological management. World J Cardiol. 2013; 5 (4): p.87-93. doi: 10.4330/wjc.v5.i4.87 . | Open in Read by QxMD
  9. van Noord C, Eijgelsheim M, Stricker BH. Drug- and non-drug-associated QT interval prolongation. Br J Clin Pharmacol. 2010; 70 (1): p.16-23. doi: 10.1111/j.1365-2125.2010.03660.x . | Open in Read by QxMD
  10. Thomas SHL, Behr ER. Pharmacological treatment of acquired QT prolongation and torsades de pointes. Br J Clin Pharmacol. 2015; 81 (3): p.420-427. doi: 10.1111/bcp.12726 . | Open in Read by QxMD
  11. Tisdale JE, Chung MK, Campbell KB, et al. Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association.. Circulation. 2020; 142 (15): p.e214-e233. doi: 10.1161/CIR.0000000000000905 . | Open in Read by QxMD
  12. Lampert R, Joska T, Burg MM, Batsford WP, McPherson CA, Jain D. Emotional and Physical Precipitants of Ventricular Arrhythmia. Circulation. 2002; 106 (14): p.1800-1805. doi: 10.1161/01.cir.0000031733.51374.c1 . | Open in Read by QxMD
  13. El-Sherif N, Turitto G, Boutjdir M. Acquired long QT syndrome and torsade de pointes. Pacing Clin Electrophysiol. 2018; 41 (4): p.414-421. doi: 10.1111/pace.13296 . | Open in Read by QxMD
  14. Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart. 2003; 89 (11): p.1363-1372. doi: 10.1136/heart.89.11.1363 . | Open in Read by QxMD
  15. Zhang S, Doyle A, Noheria A. Irregular Wide Complex Tachycardia–Mediated Cardiomyopathy. Circulation. 2019; 139 (14): p.1750-1752. doi: 10.1161/circulationaha.118.039018 . | Open in Read by QxMD
  16. Haqqani HM, Morton JB, Kalman JM. Using the 12-Lead ECG to Localize the Origin of Atrial and Ventricular Tachycardias: Part 2-Ventricular Tachycardia. J Cardiovasc Electrophysiol. 2009; 20 (7): p.825-832. doi: 10.1111/j.1540-8167.2009.01462.x . | Open in Read by QxMD
  17. Kashou AH, Noseworthy PA, DeSimone CV, Deshmukh AJ, Asirvatham SJ, May AM. Wide Complex Tachycardia Differentiation: A Reappraisal of the State‐of‐the‐Art. Journal of the American Heart Association. 2020; 9 (11). doi: 10.1161/jaha.120.016598 . | Open in Read by QxMD
  18. Pedersen CT, Kay GN, Kalman J, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace. 2014; 16 (9): p.1257-83. doi: 10.1093/europace/euu194 . | Open in Read by QxMD
  19. Schlüter T, Baum H, Plewan A, Neumeier D. Effects of Implantable Cardioverter Defibrillator Implantation and Shock Application on Biochemical Markers of Myocardial Damage. Clin Chem. 2001; 47 (3): p.459-463. doi: 10.1093/clinchem/47.3.459 . | Open in Read by QxMD
  20. Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias.. Curr Cardiol Rev. 2014; 10 (3): p.262-76. doi: 10.2174/1573403x10666140514103309 . | Open in Read by QxMD
  21. Compton SJ. Ventricular Tachycardia. In: Rottman JN, Ventricular Tachycardia. New York, NY: WebMD. Updated: December 31, 2015. Accessed: February 13, 2017.
  22. VT versus SVT with aberrancy. Updated: February 13, 2017. Accessed: February 13, 2017.
  23. Piccini JP, Allen LA, Kudenchuk PJ, Page RL, Patel MR, Turakhia MP. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death. Circulation. 2016; 133 (17): p.1715-1727. doi: 10.1161/cir.0000000000000394 . | Open in Read by QxMD
  24. Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace. 2019; 21 (8): p.1143-1144. doi: 10.1093/europace/euz132 . | Open in Read by QxMD
  25. Dukkipati SR, Choudry S, Koruth JS, Miller MA, Whang W, Reddy VY. Catheter Ablation of Ventricular Tachycardia in Structurally Normal Hearts. J Am Coll Cardiol. 2017; 70 (23): p.2909-2923. doi: 10.1016/j.jacc.2017.10.031 . | Open in Read by QxMD
  26. Dukkipati SR, Koruth JS, Choudry S, Miller MA, Whang W, Reddy VY. Catheter Ablation of Ventricular Tachycardia in Structural Heart Disease. J Am Coll Cardiol. 2017; 70 (23): p.2924-2941. doi: 10.1016/j.jacc.2017.10.030 . | Open in Read by QxMD