Ventricular tachycardia (VT)
Ventricular tachycardia (VT) is a regular, broad‑complex tachycardia originating in the ventricles from an ectopic focus or re‑entrant circuit. It may be monomorphic (stable single QRS morphology) or polymorphic (changing QRS morphology, including torsades de pointes).
Presentation ranges from asymptomatic palpitations to profound haemodynamic collapse and rapid progression to ventricular fibrillation (VF).
In the Emergency Department, the priorities are rapid recognition, assessment for life-threatening adverse features, immediate treatment according to current Advanced Life Support (ALS) principles, identification and correction of reversible causes, and prompt specialist escalation. Current Resuscitation Council UK guidance recommends synchronized cardioversion not only for VT with life-threatening adverse features but also as the preferred treatment for stable monomorphic VT.
Recognition and why VT matters
- In patients with prior myocardial infarction or structural heart disease, assume a broad‑complex regular tachycardia is VT and treat as VT unless there is convincing evidence otherwise; history of prior MI is highly predictive.
- VT carries a high risk of syncope, haemodynamic compromise, recurrence and sudden cardiac death; emergency department management determines immediate survival and the need for urgent specialist interventions such as cardioversion, antiarrhythmics, invasive support and device therapies.
Key ECG features that favour VT
Use the ECG together with clinical context to distinguish VT from supraventricular tachycardia (SVT) with aberrancy. Findings that strongly suggest VT:
- AV dissociation with...