Definition

Ventricular tachycardia (V-tach) is a rapid heart beat that originates in one of the lower chambers (the ventricles) of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute.

Description

A rapid heart rate can originate in either the left or right ventricle. Ventricular tachycardia which lasts more than 30 seconds is referred to as sustained ventricular tachycardia. A period of three to five rapid beats is called a salvo, and six beats or more lasting less than 30 seconds is called nonsustained ventricular tachycardia. Rapid ventricular rhythms are more serious than rapid atrial rhythms because they make the heart extremely inefficient. They also tend to cause more severe symptoms, and have a much greater tendency to result in death.

Although generally considered to be among the life-threatening abnormal rhythms, harmless forms of sustained V-tach do exist. These occur in people without any structural heart disease.

Causes and symptoms

Most ventricular tachycardias are associated with serious heart disease such as coronary artery blockage, cardiomyopathy, or valvular heart disease. V-tach is often triggered by an extra beat originating in either the right or left ventricle. It also occurs frequently in connection with a heart attack. V-tach commonly occurs within 24 hours of the start of the attack. It must be treated quickly to prevent fibrillation. After 48 to 72 hours of the heart attack, the risk of ventricular tachycardia is small. However, people who have suffered severe damage to the larger anterior wall of the heart have a second danger period, because V-tach often occurs during convalescence from this type of heart attack.

Sustained ventricular tachycardia prevents the ventricles from filling adequately so the heart can not pump normally. This results in loss of blood pressure, and can lead to a loss of consciousness and to heart failure.

The individual with V-tach almost always experiences palpitation, though some episodes cause no symptoms at all.

Diagnosis

Diagnosis is easily made with an electrocardiogram.

Treatment

Any episode of ventricular tachycardia that causes symptoms needs to be treated. An episode that lasts more than 30 seconds, even without symptoms, also needs to be treated. Drug therapy can be given intravenously to suppress episodes of V-tach. If blood pressure falls below normal, a person will need electric cardioversion ("shock") immediately.

Prognosis

With appropriate drug or surgical treatment, ventricular tachycardia can be controlled in most people.

Prevention

A person susceptible to sustained ventricular tachycardia often has a small abnormal area in the ventricles that is the source of the trigger event. This area can sometimes be surgically removed. If surgery is not an option, and drug therapy is not effective, a device called an automatic cardioverter-defibrillator may be implanted.