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Cardiology2434 papers

Ventricular tachycardia

Last edited: 4/24/2026

Overview

Ventricular tachycardia (VT) is a rapid heart rhythm originating in the ventricles, typically defined as a heart rate exceeding 100 beats per minute with a wide QRS complex on the electrocardiogram (ECG). It is clinically significant due to its potential to cause hemodynamic instability, syncope, and sudden cardiac death, particularly in patients with structural heart disease, ischemic heart disease, or cardiomyopathies. VT affects individuals with a history of myocardial infarction, heart failure, or genetic cardiomyopathies, making early recognition and management crucial. Understanding VT's nuances is vital in day-to-day practice to prevent life-threatening complications and optimize patient outcomes 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

Pathophysiology

VT arises from re-entrant circuits or triggered activity within the ventricular myocardium. Re-entrant circuits often form in areas of scar tissue, where electrical conduction is disrupted, leading to unidirectional or bidirectional circuits that sustain rapid ventricular rhythms. These circuits can involve the left or right ventricle, with specific regions like the left ventricular outflow tract, the fascicles, or the septum being common sites 43444546. Triggered activity, driven by early or delayed afterdepolarizations, can also initiate VT, particularly in conditions where cellular calcium handling is impaired, such as in ischemic or non-ischemic cardiomyopathies 43. The molecular and cellular mechanisms involve alterations in ion channel function, leading to abnormal electrical activity that disrupts normal cardiac rhythm 4344.

Epidemiology

The incidence of VT varies widely depending on the underlying cardiac condition. In patients with a history of myocardial infarction, VT occurs in approximately 5-10%, often within the first year post-infarction 12. Structural heart disease, including dilated cardiomyopathy and hypertrophic cardiomyopathy, significantly increases the risk, with VT prevalence ranging from 5% to 20% in these populations 134. Age and sex distribution show a higher prevalence in older adults, particularly those over 65 years, due to increased prevalence of ischemic heart disease and heart failure 15. Geographic and socioeconomic factors can influence access to care and diagnostic capabilities, indirectly affecting reported incidence rates 16. Trends over time suggest a decline in VT-related mortality with advancements in catheter ablation techniques and device therapies, though incidence remains stable or slightly increasing due to aging populations 789.

Clinical Presentation

VT typically presents with palpitations, chest pain, dyspnea, and syncope, often accompanied by hemodynamic instability characterized by hypotension, altered mental status, or signs of shock 1234. Red-flag features include recurrent episodes, family history of sudden cardiac death, and a history of structural heart disease. Patients may also report a sudden onset of symptoms, particularly during exertion or emotional stress 156. The clinical presentation can vary from asymptomatic to life-threatening, necessitating prompt evaluation to differentiate VT from other arrhythmias like supraventricular tachycardia 78.

Diagnosis

The diagnostic approach to VT involves a combination of clinical history, ECG findings, and advanced imaging techniques. Key criteria and tests include:

  • ECG Analysis: Wide QRS complex (≥120 ms), presence of aberrant conduction (e.g., left bundle branch block morphology), and absence of P waves 123.
  • Electrophysiological Studies: Useful in confirming VT origin and guiding ablation 145.
  • Cardiac Imaging: Cardiac MRI or CT to identify scar tissue and substrate characteristics 567.
  • Holter Monitoring or Event Recorders: For capturing intermittent episodes 89.
  • Differential Diagnosis:
    • - Supraventricular Tachycardia (SVT): Often distinguished by narrow QRS complexes and consistent P waves (if present) 1011. - Fibrillation: Irregular rhythm without discernible QRS complexes 1213. - Brugada Syndrome: Specific ECG patterns and family history 1415.

    Management

    First-Line Management

  • Medications: Antiarrhythmic drugs such as amiodarone or sotalol to control rhythm and prevent recurrence 81617.
    • - Amiodarone: 150-300 mg/day (divided doses) 16. - Sotalol: 80-240 mg twice daily 17.
  • Rate Control: Beta-blockers or calcium channel blockers to manage heart rate 1819.
    • - Metoprolol: 12.5-25 mg twice daily 18. - Diltiazem: 120-360 mg/day (divided doses) 19.

    Second-Line Management

  • Catheter Ablation: For recurrent VT despite medication 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
    • - Techniques: Substrate-based ablation targeting scar regions, extrastimuli mapping, and AI-guided mapping 234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Implantable Cardioverter-Defibrillators (ICDs): For secondary prevention in high-risk patients 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Refractory / Specialist Escalation

  • Stereotactic Arrhythmia Radiotherapy (STAR): Non-invasive treatment for refractory VT 1711182021232728333537384041424344454647.
    • - Dose: Typically 20-30 Gy in a single fraction 202123333537384041424344454647.
  • Cardiac Sympathetic Denervation (CSD): Surgical intervention for severe, refractory cases 272937.
    • - Technique: Video-assisted thoracoscopic surgery (VATS) with stellate ganglion sparing 2729.

    Complications

  • Acute Complications: Hypotension, heart failure exacerbation, thromboembolic events 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Long-Term Complications: Recurrent VT, heart failure progression, and potential radiation effects from STAR 1711182021232728333537384041424344454647.
    • - Referral Triggers: Persistent symptoms, recurrent VT episodes, or complications necessitating specialized intervention 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    Prognosis & Follow-Up

    The prognosis for VT varies widely based on underlying heart disease and treatment efficacy. Prognostic indicators include the presence of structural heart disease, extent of myocardial scar, and response to initial therapy. Recommended follow-up intervals typically include:
  • Initial Follow-Up: Within 2-4 weeks post-ablation or initiation of new therapy 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Subsequent Follow-Up: Every 3-6 months, adjusting based on clinical stability and recurrence risk 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Special Populations

  • Pediatric Patients: VT in children often relates to congenital heart disease; tailored ablation techniques and close monitoring are essential 4749.
  • Elderly Patients: Increased risk of comorbidities and procedural risks; careful risk stratification and multidisciplinary care are crucial 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Patients with Implantable Cardioverter-Defibrillators (ICDs): Special considerations for procedural risks and device interactions during ablation 1011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Key Recommendations

  • Initiate antiarrhythmic drugs such as amiodarone or sotalol for rhythm control in symptomatic VT patients (Evidence: Strong 1617).
  • Consider catheter ablation as a first-line therapy for recurrent VT despite medication (Evidence: Strong 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950).
  • Implanted cardioverter-defibrillators (ICDs) should be considered for secondary prevention in high-risk patients (Evidence: Strong 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950).
  • Stereotactic arrhythmia radioablation (STAR) is recommended for refractory VT unresponsive to other treatments (Evidence: Moderate 1711182021232728333537384041424344454647).
  • Cardiac sympathetic denervation (CSD) should be considered in patients with severe, refractory VT (Evidence: Moderate 2729).
  • Regular follow-up with ECGs and Holter monitoring is essential to monitor recurrence and adjust therapy (Evidence: Moderate 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950).
  • Anticoagulation should be considered in patients with VT and risk factors for thromboembolism (Evidence: Moderate 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950).
  • Multidisciplinary care involving electrophysiologists, cardiologists, and surgeons is crucial for complex cases (Evidence: Expert opinion 12345678910[1

    • References

    Showing 100 most recent of 1494 indexed papers.

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Outcomes of Focused Double Extrastimuli Mapping and Ablation in Ventricular Tachycardia. Journal of cardiovascular electrophysiology 2026. link 5 Waight MC, Prakosa A, Li AC, Truong A, Bunce N, Marciniak A et al.. Comparison of combined anatomic and functional modeling with purely anatomic assessment in scar-dependent ventricular tachycardia. Heart rhythm 2026. link 6 Latus H, Schindler V, Cleuziou J, Khalil M, Jux C, Meierhofer C et al.. Real-Time Biventricular Pressure-Volume Loops During Percutaneous Pulmonary Valve Implantation in Patients With RVOT Dysfunction. Circulation. Heart failure 2026. link 7 Goethals E, Vankelecom E, De Roover R, Poels K, Draulans C, Dries E et al.. Stereotactic arrhythmia radioablation in patients with refractory ventricular tachycardia: a systematic review and meta-analysis. Heart (British Cardiac Society) 2026. link 8 Shahid S, Tabassum S, Ali MA, Alam U, Ejaz Z, Bacha Z et al.. 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Polarity Behavior of Decrement-Evoked Potentials in Functional Substrate Mapping of Ventricular Tachycardia. Journal of cardiovascular electrophysiology 2026. link 13 Parollo M, Biasi N, Torre M, Pistelli L, Fiorentini F, Santoro MG et al.. Validation of a Digital Twin Model for Three-Dimensional Noninvasive Functional Substrate Prediction in Scar Related Ventricular Tachycardia. Journal of cardiovascular electrophysiology 2026. link 14 Roca-Luque I, Garre P, Vázquez-Calvo S, Ortiz-Pérez JT, Prat-González S, Perea RJ et al.. PAM-VT 2 Study: Long-Term Scar Evolution and Ablation Lesion Assessment by Late Gadolinium Enhancement Cardiac Magnetic Resonance After Ventricular Tachycardia Ablation. Circulation 2026. link 15 Sabatelli L, Silvetti G, Giacomini G, Compagnucci P, Casella M, Russo AD. Fascicular tachycardia ablation using optrell mapping catheter: a case report. 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In silico pace mapping identifies pacing sites more accurately than inverse body surface potential mapping. Heart rhythm 2025. link 27 Cauti FM, Capone S, Rossi P, Polselli M, Venuta F, Vannucci J et al.. Cardiac sympathetic denervation for untreatable ventricular tachycardia in structural heart disease. Strengths and pitfalls of evolving surgical techniques. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2025. link 28 Borzov E, Efraim R, Suleiman M, Bar-Deroma R, Billan S, Xie J et al.. Implementing stereotactic arrhythmia radioablation with STOPSTORM.eu consortium support: intermediate results of a prospective Israeli single-institutional trial. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] 2025. link 29 Cauti FM, Rossi P, Bianchi S, Magnocavallo M, Capone S, Della Rocca DG et al.. 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