Ventricular Tachycardia and Other Ventricular Arrhythmias

Ventricular arrhythmias, including ventricular tachycardia (VT or V-tach), premature ventricular contractions (PVCs), and ventricular fibrillation (V-fib) make it difficult for the heart to pump blood through your body. This can lead to symptoms like fainting episodes, heart palpitations, lightheadedness, chest pain, and shortness of breath.

Left untreated, ventricular tachycardia or the more chaotic ventricular fibrillation can also lead to sudden cardiac death.

Causes and Types
Ventricular arrhythmias can be caused or triggered by conditions that damage the heart, like a heart attack, coronary artery disease, cardiomyopathy, myocarditis, or valve disease.

Sometimes the wrong heart cells can also start generating electrical impulses on their own, without underlying heart disease. This is called idiopathic ventricular tachycardia.

Ventricular arrhythmias can also have genetic causes. For example, catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic form of V-tach.

Electrocardiogram (EKG)
Small electrodes placed on the skin record your heart’s electrical activity over a short period of time.

Heart Monitors
Wearable monitors can record your heart rhythm continuously for at least 24 hours, and for up to two weeks. Some only record abnormal heart rhythms when they occur and can be worn for up to 30 days. Wearable heart monitors use electrodes placed on the surface of your skin with an adhesive patch. Insertable loop monitors are surgically implanted under your skin.

Imaging Scans
Imaging scans, like an echocardiogram (an ultrasound of the heart), a CT scan, or cardiac MRI, help your doctors evaluate how well your heart contracts and its overall function. Imaging also helps doctors learn more about the condition of your heart tissue, including how much scarring you might have.

Stress Test
Your heart rhythm is evaluated while you exercise on a treadmill or stationary bicycle.

Electrophysiology (EP) Study and Catheter Mapping
In a special EP lab, thin and flexible tubes called catheters are inserted through a small incision into a large blood vessel (usually in the groin) and carefully guided to your heart. Specialized electrophysiologists use catheters or medications to stimulate your heart’s abnormal rhythm and pinpoint its origin. 

Medications
Certain medications help slow down your heart rate and reduce the risk of repeat events. They can help your heart beat in a normal, regular rhythm. If a ventricular tachycardia rhythm lasts longer than 30 seconds (doctors call this “sustained”), you may need immediate treatment with intravenous (IV) medications.

Cardioversion / Defibrillation
Carefully applied electrical shocks or medications quickly restore a normal heart rhythm.

Cardiac Ablation
This can cure some ventricular arrhythmias. Cardiac ablation is usually performed as a minimally invasive catheter-based procedure in specialized procedure rooms called EP labs or in hybrid operating rooms. Using a thin, flexible tube inserted in a blood vessel, an electrophysiologist applies heat or cold to destroy the area(s) of the heart where irregular heartbeats originate. Sometimes other methods may be needed, including injecting alcohol into the veins of the heart (this is called alcohol ablation). Epicardial cardiac ablation treats ventricular tachycardia that occurs on the heart’s outer surface by creating small scars that block stray electrical signals. Other advanced ablation techniques we offer include: 

• Ventricular fibrillation ablation
• Hybrid surgical ablation

Implantable Cardioverter Defibrillator (ICD)
This electrical device monitors your heart rhythm continuously and delivers an electrical shock to restore a normal heartbeat if it detects a life-threatening arrhythmia. ICDs can prevent sudden cardiac death caused by abnormal heart rhythms.

Sympathetic Modulation / Stellate Ganglion Block
The sympathetic nervous system, the part of your autonomic nervous system that triggers the fight-or-flight response, can provoke ventricular tachycardia and other ventricular arrhythmias. Medications injected near an important collection of nerves in the neck called stellate ganglion can help suppress these episodes temporarily. Surgeons can also remove these nerves. This is called a sympathectomy.

Stereotactic Body Radiation Therapy (SBRT)
Stereotactic body radiation therapy (SBRT) is a noninvasive treatment that uses targeted, high-dose radiation to scar heart tissue where your ventricular arrhythmia begins. This helps prevent arrhythmias from beginning. SBRT is only recommended for certain people whose ventricular arrhythmia has not responded to other treatment.

Specialized Procedures for Less Common Arrhythmias 
The Duke Heart Center is a referral center for complex ventricular arrhythmias. Our electrophysiologists are trained and experienced in advanced ablation techniques. Duke’s ventricular tachycardia program offers the most innovative treatments for ventricular arrhythmias. 

Duke is among a handful of centers with substantial expertise in epicardial catheter ablation, which treats ventricular tachycardia that occurs on the heart’s outer surface. We were the first center in North Carolina to offer stereotactic body radiation therapy (SBRT) -- an experimental therapy that delivers a quick, targeted dose of radiation to the heart -- to treat life-threatening ventricular tachycardia in people who are not candidates for traditional ablation.

Expert, Team Approach to Care
Our experts help draft clinical guidelines for ventricular arrhythmias, and we participate in programs that educate the next generation of heart rhythm specialists. We work closely with cardiothoracic surgeons and advanced heart failure specialists to ensure you receive comprehensive care.