Ventricular tachycardia

What is ventricular tachycardia?

Ventricular tachycardia is a potentially life-threatening cardiac arrhythmia that must be treated as soon as possible. The medical term tachycardia is defined as a heart rate of over 100 beats per minute. For reference, a normal resting heart rate usually lies between 60 and 80 beats per minute.

The heart can be divided into its left and right part, each with one atrium and one ventricle. The heart ventricles are also referred to as heart chambers. Tachycardias are classified based on the site of their origin. In the case of a ventricular tachycardia, the site of origin is in the ventricles.

This type of cardiac arrhythmia is dangerous because it can progress to a life-threatening ventricular fibrillation, which can reach a heart rate of more than 320 beats per minute. If the heart beats too fast, it can no longer eject blood efficiently. As a result, the peripheral organs can no longer be sufficiently supplied with oxygen. If the circulation can no longer be maintained due to a cardiac arrhythmia, this is called a cardiogenic shock, which is a life-threatening state. 

How does cardiac arrhythmia develop?

Ventricular tachycardia is classified into primary and secondary forms. The secondary form always arises as a consequence of another medical condition. Primary forms are much less common and are also called idiopathic ventricular tachycardias. 

Among the most common causes of ventricular tachycardia are disorders of the heart, particularly coronary artery disease (CAD). In CAD, the coronary arteries are altered by arteriosclerosis, which narrows the vessels and limits the blood supply to the heart muscle. Ventricular tachycardia can arise due to an undersupply of heart muscle cells (myocardial cells).

Moreover, congestive heart failure (CHF) is also one of the leading causes of ventricular tachycardia. Particularly systolic heart failure, in which the heart’s pumping function is impaired, can trigger ventricular tachycardia. Diseases of the heart valves and cardiomyopathies can also lead to cardiac arrhythmias. 

Furthermore, electrolyte disturbances, especially potassium and magnesium, are an important risk factor for triggering life-threatening arrhythmias.

What are the risk factors?

Since ventricular tachycardia arises as a consequence of another underlying heart disease, the presence of such a condition is a major risk factor. This is particularly true for CAD, which is the most common cause of secondary ventricular tachycardia. Therefore, risk factors for CAD are also risk factors for ventricular tachycardia.

Non-modifiable risk factors that promote the development of arteriosclerosis of the coronary vessels are age, male sex, and family history. In contrast, modifiable risk factors are high blood pressure, lipid metabolism disorders, diabetes mellitus, and smoking.

Therefore, preventive measures involve avoidance of the modifiable risk factors and treatment of underlying heart conditions.

How does one notice ventricular tachycardia?

The symptoms of ventricular tachycardia are highly variable and depend on the duration of the arrhythmia. 

If a ventricular tachycardia lasts longer than 30 seconds, it is called a sustained arrhythmia. Shorter episodes of arrhythmia are referred to as non-sustained and are generally associated with milder symptoms.

Possible symptoms include a noticeably accelerated heartbeat, which patients describe as a racing heart. Additionally, many patients report shortness of breath, chest pain and anxiety. Sustained ventricular tachycardias may cause blood to back up before the heart, leading to pulmonary edema. Furthermore, insufficient supply of oxygen to the brain can lead to loss of consciousness. In severe cases these arrhythmias can cause cardiogenic shock and cardiac arrest.

How is ventricular tachycardia diagnosed?

The often pronounced symptoms usually point to a cardiac problem as the cause of the symptoms. Therefore, an ECG is recorded. The electrocardiogram records the electrical excitation of the heart and provides important information about the heart rhythm and function. It is the most important tool for detecting cardiac arrhythmias. 

The ECG can show typical changes for ventricular tachycardia, identifying the cause of the symptoms quickly. However, in some cases only nonspecific findings are visible, requiring further analysis of the data.

If the type of cardiac arrhythmia cannot be determined, further diagnostic workups may become necessary, such as an echocardiogram (ultrasound of the heart). Whether these are performed depends on the urgency of the case, the severity of the symptoms, how stable the patient is, and in which setting the symptoms occurred. In a clinic or hospital, further diagnostic tools are readily available.

How is ventricular tachycardia treated?

Ventricular tachycardia is a potentially life-threatening condition and must be treated as soon as possible. The primary treatment goals are to limit the cardiac arrhythmia and to maintain circulation.

One treatment option includes cardioversion – the administration of an electrical shock. This is done to resynchronize the electrical activity of the heart cells to restore a normal rhythm. Additionally, anti-arrhythmic drugs may be administered.

Moreover, general measures to maintain circulation, such as oxygen administration and monitoring vital parameters are essential. 

Generally, the underlying cause of the ventricular tachycardia should be identified and treated. This may require correcting electrolyte imbalances, performing a heart ultrasound (echocardiogram), or even cardiac catheterization.

Following acute stabilization of the patient, a thorough diagnostic evaluation should be performed. The subsequent treatment should aim at preventing another dangerous cardiac arrhythmia. Common treatments include catheter ablation, in which specific areas of the heart muscle (myocardium) are ablated with the help of a catheter. In some cases implantation of a defibrillator (implantable cardioverter-defibrillator, ICD) may be considered. In the event of another tachyarrhythmia, the defibrillator can deliver a shock automatically.

What are the prognosis and chances of recovery?

The prognosis depends on the underlying cause. Patients with an idiopathic ventricular tachycardia, who do not have any further heart conditions, respond typically very well to anti-arrhythmic medication or catheter ablation. The prognosis in these cases is generally very good.

However, no general statement can be made regarding the chances of recovery from secondary ventricular tachycardia. The prognosis heavily depends on the underlying disease and its severity, as well as on the general condition of the patient.

Which physicians & clinics are specialists for the diagnosis & treatment of ventricular tachycardia?

Ventricular tachycardia must always be treated as quickly as possible. In acute cases, treatments fall within the scope of the emergency department, meaning physicians from various specialties with training in emergency medicine are responsible. Specialists in internal medicine and cardiology are particularly suitable for investigatung possible underlying heart conditions as triggers of the arrhythmia. 

We would like to help patients find a suitable and competent specialist for the treatment of their condition. All physicians listed here have been carefully reviewed and selected by our team. They are specialists in their respective fields and experts in the treatment of ventricular tachycardia. Benefit from the expertise and experience of our specialists and arrange a first consultation directly.