Ventricular tachycardia
- Professor Mark Westwood, Consultant Cardiologist
Ventricular tachycardia is a type of abnormal heartbeat called an arrhythmia. It means your heart is beating too quickly and isn’t pumping enough blood around your body.
What happens in ventricular tachycardia?
Your heartbeat is controlled by electrical signals (impulses). These signals travel through your heart and make it contract. If you have ventricular tachycardia, faulty electrical signals in your ventricles (the lower chambers of your heart) cause your heart to beat faster than normal.
Normally, at rest, your heart will beat between 60 and 100 times a minute. If you have ventricular tachycardia, it beats over 100 times per minute – often more than 120 times per minute. Even though your heart may be beating faster, it’s not pumping blood as well. Your ventricles are beating so quickly that they may not have enough time to fill up with blood between beats. This means your heart can’t pump enough blood to the rest of your body.
Heart arrhythmias - ventricular tachycardia
Ventricular tachycardia| Watch in 1:12 minutes
Ventricular tachycardia is a common heart arrhythmia. Learn what causes this condition during this short video.
Your heart is a muscular organ, which lies in the centre of your chest.
Your heartbeat is controlled by electrical impulses, which travel across the heart, making it contract.
The atria contract first, sending blood into the ventricles.
The ventricles then contract, sending blood to the lungs and around the body.
Nerves supplying the heart change the rate at which impulses are sent across the heart muscle to meet the needs of the body.
In supraventricular tachycardia (or SVT) the irregular electrical impulses pass across the ventricles and back up into the atria in a circle, rather than travelling from the atria to the ventricles in one direction as they should.
This makes the heart beat faster.
Types of ventricular tachycardia
There are two types of ventricular tachycardia attacks.
- Non-sustained ventricular tachycardia attacks stop on their own in under 30 seconds.
- Sustained ventricular tachycardia attacks last for longer than 30 seconds – they usually cause symptoms and you may need treatment to stop them.
Causes of ventricular tachycardia
Ventricular tachycardia usually happens in people who have already had significant problems with their heart. This may be:
This may be:
- a previous heart attack
- coronary heart disease
- heart muscle disease (cardiomyopathy)
Other problems affecting the structure of your heart may also lead to ventricular tachycardia. These include problems that you’re born with (congenital heart disease), such as long QT syndrome and Brugada syndrome.
It’s also possible to get ventricular tachycardia if you don’t have any underlying problems with your heart. Certain things can trigger ventricular tachycardia if you’re already at risk. Ventricular tachycardia causes can include:
- some medicines
- physical or mental stress
- too much caffeine
- illegal drugs such as cocaine
- imbalances of certain chemicals in your blood (such as too little potassium, calcium or magnesium)
Symptoms of ventricular tachycardia
If you have brief episodes of ventricular tachycardia that stop on their own, you may not get any symptoms at all. But ventricular tachycardia symptoms can include:
- palpitations (a thumping or fluttering feeling in your chest)
- chest pain or discomfort
- difficulty breathing
- feeling sick
- sweating a lot
- feeling light-headed or passing out (fainting)
If you get any of these symptoms and they’re relatively mild, see your GP. If the symptoms are severe and come on suddenly, you should go to your nearest accident and emergency department.
Diagnosis of ventricular tachycardia
If you see your GP with symptoms of an arrhythmia, they’ll ask about your symptoms and examine you. They’ll also ask about your medical history and family history. Your doctor will check your:
- pulse
- blood pressure
- heartbeat
You’ll need to have a test called an electrocardiogram (ECG). An ECG records the electrical activity of your heart to see how well it's working. You may need to have an ambulatory ECG. This records your heartbeat over a period of 24 hours or more while you go about your normal daily activities. You may also be offered a self-adhesive wireless ECG monitor that you stick to your chest. You can wear this patch for up to 2 weeks.
If it’s not been possible to record the abnormal heartbeat using a monitor outside your body, you may have an implantable loop recorder. This is a small device that’s implanted under your skin and is programmed to record abnormal heart rhythms. Your GP will need to refer you to a cardiologist (a doctor specialising in diagnosing and treating heart conditions) to have this.
If your ECG test shows you have ventricular tachycardia, your doctor will ask you to have more tests. These tests may include the following.
- Blood tests. These will check for certain substances in your blood that can be associated with ventricular tachycardia or other conditions that may be causing your symptoms.
- Echocardiogram. This is a type of scan that uses ultrasound (sound waves) to produce a clear image of your heart muscles and valves to see how well these are working.
- Chest X-ray. This allows your doctor to look for any changes in your heart or lungs that might be causing the problem.
- An exercise ECG (cardiac stress test). This is when you have an ECG while you exercise on a treadmill to see if it triggers an arrhythmia.
- Coronary angiography. This is a type of X-ray that uses a dye to show your coronary arteries. It can show if they’re narrowed or blocked.
- An MRI scan of your heart. This is to check if you have any problem with your heart muscle.
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Treatment of ventricular tachycardia
Ventricular tachycardia treatment aims to:
- stop the attack
- get your heart back to a normal rhythm
- prevent any more attacks
Sometimes episodes of ventricular tachycardia stop on their own and don’t need any treatment.
The type of treatment you have will depend on how serious your ventricular tachycardia is and what’s causing it. If it’s caused by an underlying health condition such as high blood pressure, your doctor will treat that too.
Stopping an attack
If ventricular tachycardia causes your heart to stop (a cardiac arrest), you’ll need immediate defibrillation (electric shock treatment). You’ll also need cardiopulmonary resuscitation (CPR) to re-start your heart.
If you don’t need defibrillation but your ventricular tachycardia has been going on for some time, you may have one or more of the following to stop it.
- Electrical cardioversion. This uses an electric shock to restore your rapid heartbeat back to normal. It’s like defibrillation, but the electrical burst can be timed.
- Antiarrhythmic medicines such as amiodarone through a drip in your arm.
Long-term treatment
If your doctor thinks you could keep having ventricular tachycardia attacks, they’ll offer you treatment to help prevent or stop more attacks. The treatment you’re offered will depend on your circumstances. Your doctor will discuss your options with you. You may be offered one or more of the following.
Implantable cardioverter defibrillator (ICD)
Most people who’ve had a ventricular tachycardia attack without a treatable cause have an implantable cardioverter defibrillator (ICD) fitted. An ICD is a device that’s put under your skin or muscle, usually near your collarbone, and has leads going into your heart. It detects when an attack of ventricular tachycardia is starting. Then it delivers electrical pulses or shocks to restore your heartbeat to normal.
A shock from an ICD can feel like a sharp thump or kick. It’s a good idea to know what to expect so you can prepare yourself and plan what to do in advance. If someone is touching you when your ICD delivers a shock, they’ll notice the jolt and may feel a tingling sensation. But don’t worry – it won’t harm them.
The first time you get a single shock, you should get the device checked by the ICD centre to make sure it’s working properly. You may not need to get the device checked after every shock, unless you feel unwell. But follow the advice given to you by your clinic. Your clinic may ask you to let them know whenever you have a shock.
If the device gives you several shocks, go to an accident and emergency department or call an ambulance. A doctor will check your device to find out why it gave you the shocks. You should also seek immediate medical advice if you have symptoms or still feel unwell after an ICD shock.
You’ll usually have check-ups every three months or so to check how well your ICD is working. If you’re doing well, your check-ups may be once a year. With some types of ICD, your clinic can monitor them remotely using software installed in your home.
Medicines
You may be prescribed medicines instead of or as well as having an ICD to help control your heart rate and rhythm. Medicines you may have include:
- beta-blockers
- calcium-channel blockers
- other antiarrhythmic medicines such as amiodarone
Always read the patient information leaflet that comes with your medicine and ask your doctor if you have any questions.
Radiofrequency ablation
Depending on what’s causing your ventricular tachycardia, you may be given the option of having radiofrequency ablation to stop future attacks. Ablation uses radiofrequency energy to destroy the tissue in your heart that's disrupting or causing abnormal electrical signals.
You may have:
- a catheter ablation: a thin tube (an electrode catheter) is passed up to your heart through a vein in your groin
- an epicardial ablation: the catheter is passed through the skin of your chest and into the outer layer of your heart wall
Lifestyle changes
Your doctor may also advise you to make some lifestyle changes to reduce your risk of more ventricular tachycardia attacks. These may include:/p>
- changing your diet to reduce high cholesterol levels
- avoiding strenuous physical activity, at least until your symptoms are under control
- give up smoking – this can reduce your risk of sudden cardiac death from ventricular tachycardia
Driving with ventricular tachycardia
If you have ventricular tachycardia, you shouldn’t drive for at least four weeks if your symptoms could affect your ability to drive safety. These include dizziness and fainting. If this is the case, you should let the Driver and Vehicle Licensing Agency (DVLA) know. The DVLA provides advice and information about driving with health conditions.
If your ventricular tachycardia has been controlled for at least four weeks, you should be able to start driving again. But speak to your doctor first. You’ll also need to check when you can drive after having certain procedures, such as catheter ablation or an implantable cardioverter defibrillator (ICD) fitted.
The rules about driving are different if you have an arrhythmia and drive a lorry or are responsible for passengers. You’ll need to speak to your doctor and check the DVLA’s advice for your condition.
Complications of ventricular tachycardia
It’s important to get treatment for ventricular tachycardia straightaway. If an attack lasts for a long time or is very fast and isn’t treated quickly, it can cause ‘sudden cardiac death’.
Ventricular tachycardia can sometimes lead to another type of arrhythmia called ventricular fibrillation. This is when electrical signals fire off in different areas of your ventricles at the same time. It causes an extremely fast, life-threatening heart rhythm. Your heart then can’t beat properly, which means it pumps out little or no blood. Ventricular fibrillation is more likely to lead to sudden cardiac death. But it can be reversed if you get treatment straight away.
Watch our animation to see what happens in ventricular fibrillation.
Heart arrhythmias - ventricular fibrillation
Ventricular fibrillation | Watch in 1:15 minutes
Heart arrhythmias such as ventricular fibrillation are common. This video explains what the symptoms, causes and treatments are.
Your heart is a muscular organ, which lies in the centre of your chest.
Your heartbeat is controlled by electrical impulses, which travel across the heart, making it contract.
The atria contract first, sending blood into the ventricles.
The ventricles then contract, sending blood to the lungs and around the body.
Nerves supplying the heart change the rate at which impulses are sent across the heart muscle to meet the needs of the body.
In supraventricular tachycardia (or SVT) the irregular electrical impulses pass across the ventricles and back up into the atria in a circle, rather than travelling from the atria to the ventricles in one direction as they should.
This makes the heart beat faster.
Ventricular tachycardia is most common in people who already have a heart problem, such as coronary artery disease, a previous heart attack or heart muscle disease (cardiomyopathy). But there are other possible causes too. For more information, see our Causes of ventricular tachycardia section.
Lots of people live a full life with ventricular tachycardia that’s been diagnosed and treated. There are long-term treatments, such as medicines or having an implantable cardioverter defibrillator (ICD) fitted. You may not have another attack for years. For more information, see our Treatment of ventricular tachycardia section.
Cardioversion
Cardioversion is a procedure to help return your heart’s rhythm to normal if it’s beating irregularly (unevenly) or too fast.
Supraventricular tachycardia
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