In this course, we explain the re-entrant mechanism generating ventricular tachycardia in the setting of structural heart disease. We explain the mechanism underlying incomplete AV dissociation in a ventricular tachycardia. We will teach you how to recognise this diagnostically important phenomenon on the ECG. You will learn how to divide cases of broad complex tachycardia into right or left bundle branch block morphologies. We teach you aspects of ECG analysis which will help you to make the crucial distinction between VT and SVT with aberrancy. You will learn how to interpret the presence or absence of a response to intravenous adenosine in a broad complex tachycardia. We discuss variants of ventricular tachycardia occurring in the absence of structural heart disease and their identification on the ECG. We will also teach you how to recognise artefact on the ECG mimicking VT (‘pseudo-ventricular tachycardia’). We detail the terminology used in the description of ventricular tachycardia. The ‘essential reading’ section of the bibliography contains links to papers which have been selected to reinforce and enhance the lessons learned in the videos. These papers should be read before attempting the quiz. In the quiz, we present informative clinical cases which will confirm that you have acquired the skills listed in the learning objectives of this course and which will, reinforce those skills.
Planner and Author: Dr John Seery MB PhD
Planner: Dr Karen Strahan PhD (University of Cambridge), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
Upon successful completion of this activity, you will be able to:
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Planners and faculty for this activity have no relevant financial relationships with commercial interests to disclose.
Grant RP. Spatial Vector Electrocardiography: A Method for Calculating the Spatial Electrical Vectors of the Heart from Conventional Leads. Circulation. 1950;11:676-95.
Martin R et al. Ventricular tachycardia isthmus characteristics: Insights from high density mapping. Arrhythmia & Electrophysiol Review. 2019;8(1).
Martin R et al. Characteristics of scar-related tachycardia circuits using ultra-high-density mapping. Circulation: Arrhythmia and Electrophysiology. 11(10).
Goldreyer BN and Biggar JT. Ventriculo-atrial Conduction in Man. Circulation. 1970:71:935-46.
Papanastasiou CA et al. A rare case of pseudo-atrial flutter waves in a patient with essential tremor. Cureus 2019;11(1):e3934. DOI 10.7759/cureus.3934
Wang KW and Benditt DG. AV Dissociation, an Inevitable Response. Ann Noninvasive Electrocardiol. 2011;16(3):227-31.
Kistin AD. Retrograde Conduction to the Atria in Ventricular Tachycardia. Circulation. 1961;24:236–249.
de Riva M et al. Twelve-Lead ECG of Ventricular tachycardia in Structural Heart Disease. Circulation. 2015;8(4):951-62.
Igarashi M et al. Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy and Apical Aneurysm. JACC Clin Electrophysiol. 2018;4(3):339-50.
Enriquez A et al. How to use the 12-lead ECG to predict the site of origin of idiopathic ventricular arrhythmias. Heart Rhythm. 2019;16:1538-44.
Mizuno H. Mapping of ventricular tachycardia in patients with structural heart disease. J Arrhythm. 2014;30(4):283-91.
Garmel GM. Wide Complex Tachycardias: Understanding this Complex Condition Part 1 – Epidemiology and Electrophysiology. West J Emerg Med. 2008;9:28-39.
Hakan O et al. Adenosine-Responsive Wide QRS Complex Tachycardia: What is the Mechanism? J Cardiovasc Electrophysiol. 1990:10;1688-9.
Marriot HJL et al. Ventricular Fusion Beats. Circulation. 1962;26: 880-4.
Vereckei A. Current Algorithms for the Diagnosis of wide QRS Complex Tachycardias. Curr Cardiol Reviews. 2014:10:262-76.
Alzand BSN and Crijns HJGM. Diagnostic criteria of broad QRS complex tachycardia: decades of evolution. EP Europace. 2011;13(4):465-72.
Knight BP et al. Clinical consequences of electrocardiographic artefact mimicking ventricular tachycardia. N Engl J Med. 1999;341:1270-4.
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Acadoodle, Ltd designates this enduring material activity for a maximum of 5.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.