Ventricular Tachycardia
VT encompasses multiple mechanisms and substrates. Monomorphic VT in structural heart disease is often related to reentry through or around scar, while idiopathic VTs may have focal mechanisms.
1. What might the surface ECG tell us?
A wide-complex tachycardia requires careful differential diagnosis; QRS morphology can provide clues to ventricular origin and exit region.
2. What might we see intracardially?
Intracardiac ventricular timing, specialized potentials, and substrate electrograms may be integrated with imaging and mapping.
Technologist mindset
Describe the sequence before naming the mechanism. Ask what is earliest, what follows, whether atrial and ventricular activation are linked, and whether the pattern changes with pacing.
3. Pacing clues
Programmed ventricular stimulation can induce VT and pacing during VT may help characterize reentrant circuits when clinically safe and appropriate.
4. Mapping concept
Mapping may combine activation, entrainment, pace mapping and substrate characterization depending on hemodynamic tolerance and mechanism.
5. Ablation concept
Ablation strategy depends strongly on VT mechanism and substrate; scar-related procedures may target critical channels or abnormal substrate rather than a single focal site.
Quick knowledge check
What is the best learning sequence for VT?
Professional reference
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Founder-authored educational summary. External expert review is not implied unless specifically stated.