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===Prognosis===
===Prognosis===


In 1930, Strauss<ref>Strauss MB(1930). Paroxysmal ventricular tachycardia. ''Am J Med Sci'' 179:337.</ref> correlated prognosis with the presence or absence of organic heart disease. It was noted that 60% of the cases occurred during the fifth and sixth decade of life, with a male preponderance. [[Congestive heart failure]] was present in two-thirds of the patient population and [[digitalis]] had been administered before the onset of the tachycardia in half of the patients. [[Quinidine]] sulfate was acutely successful in controlling paroxysms in all cases in which it was employed. There were many other case series which had similar findings.<ref>Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref><ref>Riseman JEF, Linenthal H(1941). Paroxysmal ventricular tachycardia. Its favorable prognosis in the absence of acute cardiac damage and its treatment with parenterally administered quinine dihydrochloride. ''Am Heart J'' 22:219.</ref><ref>Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref>Cooke WT, White PD(1943). Paroxysmal ventricular tachycardia. ''Br Heart J'' 5:33.</ref><ref>Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref>Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref> Most investigators classified [[ventricular tachycardia]] into two forms on the basis of pattern and duration of the arrhythmia. Interrmittent [[ventricular tachycardia]] was defined as "runs of ventricular tachycardia separated by periods of normal rhythm, the latter often showing ventricular [[extrasystoles]]"23 or "short paroxysms of tachycardia lasting seconds or minutes which ceased spontaneously or were controlled readily in most cases by therapy." Persistent [[ventricular tachycardia]] was thereby defined as being of longer duration and without periods of interruption. Several authors found important differences in prognosis between these groups.23,28,29 In all these series, the prognosis in patients with no identified organic heart disease was better than in those patients with abnormal hearts. Paroxysmal [[ventricular tachycardia]] in young patients with otherwise apparently healthy hearts was thought by several investigators to run a benign clinical course.25, 30
In 1930, Strauss<ref>Strauss MB(1930). Paroxysmal ventricular tachycardia. ''Am J Med Sci'' 179:337.</ref> correlated prognosis with the presence or absence of organic heart disease. It was noted that 60% of the cases occurred during the fifth and sixth decade of life, with a male preponderance. [[Congestive heart failure]] was present in two-thirds of the patient population and [[digitalis]] had been administered before the onset of the tachycardia in half of the patients. [[Quinidine]] sulfate was acutely successful in controlling paroxysms in all cases in which it was employed. There were many other case series which had similar findings.<ref>Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref><ref>Riseman JEF, Linenthal H(1941). Paroxysmal ventricular tachycardia. Its favorable prognosis in the absence of acute cardiac damage and its treatment with parenterally administered quinine dihydrochloride. ''Am Heart J'' 22:219.</ref><ref>Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref>Cooke WT, White PD(1943). Paroxysmal ventricular tachycardia. ''Br Heart J'' 5:33.</ref><ref>Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref>Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref><ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref><ref name="pmid14196126">{{cite journal| author=MACKENZIE GJ, PASCUAL S| title=PAROXYSMAL VENTRICULAR TACHYCARDIA. | journal=Br Heart J | year= 1964 | volume= 26 | issue=  | pages= 441-51 | pmid=14196126 | doi= | pmc=PMC1018162 | url= }} </ref><ref name="pmid13041996">{{cite journal| author=FROMENT R, GALLAVARDIN L, CAHEN P| title=Paroxysmal ventricular tachycardia; a clinical classification. | journal=Br Heart J | year= 1953 | volume= 15 | issue= 2 | pages= 172-8 | pmid=13041996 | doi= | pmc=PMC479483 | url= }} </ref> Most investigators classified [[ventricular tachycardia]] into two forms on the basis of pattern and duration of the arrhythmia. Interrmittent [[ventricular tachycardia]] was defined as "runs of ventricular tachycardia separated by periods of normal rhythm, the latter often showing ventricular [[extrasystoles]]"<ref>Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref> or "short paroxysms of tachycardia lasting seconds or minutes which ceased spontaneously or were controlled readily in most cases by therapy." Persistent [[ventricular tachycardia]] was thereby defined as being of longer duration and without periods of interruption. Several authors found important differences in prognosis between these groups.<ref>Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. ''Arch Intern Med'' 71:137.</ref><ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref><ref name="pmid14196126">{{cite journal| author=MACKENZIE GJ, PASCUAL S| title=PAROXYSMAL VENTRICULAR TACHYCARDIA. | journal=Br Heart J | year= 1964 | volume= 26 | issue=  | pages= 441-51 | pmid=14196126 | doi= | pmc=PMC1018162 | url= }} </ref> In all these series, the prognosis in patients with no identified organic heart disease was better than in those patients with abnormal hearts. Paroxysmal [[ventricular tachycardia]] in young patients with otherwise apparently healthy hearts was thought by several investigators to run a benign clinical course.<ref>Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. ''Br Heart J'' 9:241.</ref><ref name="pmid13041996">{{cite journal| author=FROMENT R, GALLAVARDIN L, CAHEN P| title=Paroxysmal ventricular tachycardia; a clinical classification. | journal=Br Heart J | year= 1953 | volume= 15 | issue= 2 | pages= 172-8 | pmid=13041996 | doi= | pmc=PMC479483 | url= }} </ref>
With advent of more refined investigations such as [[cardiac catheterization]], [[echocardiography]], and [[endomyocardial biopsy]], anatomic and histologic details were found about “primary electrical disease”. Various investigators attempted to ascribe prognostic significance to morphologic characteristics of ventricular tachycardia. Lundy and McLellan categorized ventricular tachycardia by bundle branch pattern and assumed incorrectly the ventricular origin of the tachycardias from these morphologies.31
With advent of more refined investigations such as [[cardiac catheterization]], [[echocardiography]], and [[endomyocardial biopsy]], anatomic and histologic details were found about “primary electrical disease”. Various investigators attempted to ascribe prognostic significance to morphologic characteristics of ventricular tachycardia. Lundy and McLellan categorized ventricular tachycardia by bundle branch pattern and assumed incorrectly the ventricular origin of the tachycardias from these morphologies.<ref>Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. ''Ann Intern Med'' 7:812.</ref>
A distinctive form of ventricular tachycardia with beat-to-beat alteration of QRS axis in a single lead has been called “bidirectional” tachycardia and was first described by Schwensen in 1922.32 He observed its occurrence during [[atrial fibrillation]] and linked it to digitalis intoxication. Palmer and White reported its poor prognosis.33 The studies which followed showed the same finding of poor prognosis with digitalis. 26, 28
A distinctive form of ventricular tachycardia with beat-to-beat alteration of QRS axis in a single lead has been called “bidirectional” tachycardia and was first described by Schwensen in 1922.<ref>Schwensen, C: Ventricular tachycardia as a result of tho administration of digitalis. Heart. 9:199, 1922.</ref> He observed its occurrence during [[atrial fibrillation]] and linked it to digitalis intoxication. Palmer and White reported its poor prognosis.33 The studies which followed showed the same finding of poor prognosis with digitalis.<ref>Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. ''Ann Intern Med'' 28:989.</ref><ref name="pmid15401194">{{cite journal| author=ARMBRUST CA, LEVINE SA| title=Paroxysmal ventricular tachycardia; a study of 107 cases. | journal=Circulation | year= 1950 | volume= 1 | issue= 1 | pages= 28-40 | pmid=15401194 | doi= | pmc= | url= }} </ref><ref name="pmid13617190">{{cite journal| author=HERRMANN GR, PARK HM, HEJTMANCIK MR| title=Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study. | journal=Am Heart J | year= 1959 | volume= 57 | issue= 2 | pages= 166-76 | pmid=13617190 | doi= | pmc= | url= }} </ref>


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Revision as of 01:21, 22 September 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]

Historical Perspective

Early Clinical and Experimental Observations

The first electrocardiographic description and evidence of Ventricular Tachycardia (VT) was given by Thomas Lewis in 1909. He described a patient with shortness of breath, precordial pain, and dropsy in whom he observed from three to eleven "successive extrasystoles".[1] He deduced from the electrocardiogram, venous pulse recording, and clinical evidence that the rhythm was of ventricular origin. In 1906, Einthoven had recorded ventricular premature beats and ventricular bigeminy using his string galvanometer.[2] In 1906 Gallavardin did landmark work in France in which he found the reason of instability of VT and its ability to convert in Ventricular Fibrillation.3 He challenged the fact that ventricular tachycardia was no more than a succession of extrasystoles suggesting that although the two phenomena were intimately related, the same mechanism might not be responsible for both.[3][4] Lewis and Smith did experimentation with dogs by simulating VT by ligating coronary arteries and was able to find characteristics of VT as we have described in the other sections.[5][6]


Electrocardiographic Features

Robinson and Herrmann, in 1921, suggested that coronary occlusion was a frequent cause of ventricular tachycardia and the prognosis in these cases appeared to be poor.[7] They also suggested the most initial criteria for VT classification. That was modified later by Rosenberg as well as Dressler and Roesler who pointed out the occasional occurrence of fusion beats in tracings showing the arrhythmia.[8][9] Since then we have come a long way in making of the diagnostic criteria better with advent of Esophageal[10][11] & Venous leads and Invasive Electrophylogic Studies.[12]

Physical Examination

Initially Phlebography was very popular amongst scientists for features of VT. Prinzmetal and Kellogg in 1934 concluded that slower, independent A waves might be encountered in two-thirds of cases of VT.[13] Schrire and Vogelpoel discovered that the so-called "cannon" A is encountered in presence of atrioventricular dissociation, but could occur in regular fashion at the same rate in nodal tachycardias.[14] The AV dissociation and its reflection was demonstrated by Wilson et al. in 1964. [15] Levine was the first who noted slight irregularity in cycle length in patients with ventricular tachycardia which was audible with the stethoscope.[16] In 1927, he mentioned variation in intensity of the first heart sound, due to atrioventricular dissociation, and extended these observations in conjunction with Harvey in 1948.[17][18] Harvey and Corrado demonstrated multiple low-frequency sounds audible in ventricular tachycardia as a differential point.[19]

Prognosis

In 1930, Strauss[20] correlated prognosis with the presence or absence of organic heart disease. It was noted that 60% of the cases occurred during the fifth and sixth decade of life, with a male preponderance. Congestive heart failure was present in two-thirds of the patient population and digitalis had been administered before the onset of the tachycardia in half of the patients. Quinidine sulfate was acutely successful in controlling paroxysms in all cases in which it was employed. There were many other case series which had similar findings.[21][22][23][24][25][26][27][28][29][30] Most investigators classified ventricular tachycardia into two forms on the basis of pattern and duration of the arrhythmia. Interrmittent ventricular tachycardia was defined as "runs of ventricular tachycardia separated by periods of normal rhythm, the latter often showing ventricular extrasystoles"[31] or "short paroxysms of tachycardia lasting seconds or minutes which ceased spontaneously or were controlled readily in most cases by therapy." Persistent ventricular tachycardia was thereby defined as being of longer duration and without periods of interruption. Several authors found important differences in prognosis between these groups.[32][27][28][29] In all these series, the prognosis in patients with no identified organic heart disease was better than in those patients with abnormal hearts. Paroxysmal ventricular tachycardia in young patients with otherwise apparently healthy hearts was thought by several investigators to run a benign clinical course.[33][30] With advent of more refined investigations such as cardiac catheterization, echocardiography, and endomyocardial biopsy, anatomic and histologic details were found about “primary electrical disease”. Various investigators attempted to ascribe prognostic significance to morphologic characteristics of ventricular tachycardia. Lundy and McLellan categorized ventricular tachycardia by bundle branch pattern and assumed incorrectly the ventricular origin of the tachycardias from these morphologies.[34] A distinctive form of ventricular tachycardia with beat-to-beat alteration of QRS axis in a single lead has been called “bidirectional” tachycardia and was first described by Schwensen in 1922.[35] He observed its occurrence during atrial fibrillation and linked it to digitalis intoxication. Palmer and White reported its poor prognosis.33 The studies which followed showed the same finding of poor prognosis with digitalis.[36][27][28]

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References

  1. ↑ Lewis T(1909). Single and successive extrasystoles. Lancet 1:382.
  2. ↑ Einthoven W(1906). Le telecardiogramme. Arch Int Physiol 4:132.
  3. ↑ Gallavardin L(1922). Extrasystolie ventriculaire a paroxysmes tachycardiques prolonges. Arch Mal Coeur 15:298.
  4. ↑ Gallavardin, L(1926). Tachycardie ventriculaire terminale: complexes alternants ou multiformes: ses rapports avec une forme severe d'extra-systolie ventriculaire. Arch Mal Coeur 19:153.
  5. ↑ Lewis T(1909). The experimental production of paroxysmal tachycardia and the effects of ligation of the coronary arteries. Heart 1:98.
  6. ↑ Smith FM(1918). The ligation of coronary arteries with electrocardiographic study. Arch Intern Med, 22:8.
  7. ↑ Robinson, GC, Herrmann CR(1921). Paroxysmal tachycardia of ventricular origin and its relation to coronary occlusion. Heart 8:59.
  8. ↑ Rosenberg DH(1940). Fusion beats. J Lab Clin Med 25:919.
  9. ↑ DRESSLER W, ROESLER H (1952). "The occurrence in paroxysmal ventricular tachycardia of ventricular complexes transitional in shape to sinoauricular beats; a diagnostic aid". Am Heart J. 44 (4): 485–93. PMID 12976333.
  10. ↑ BUTTERWORTH S, POINDEXTER CA (1946). "The esophageal electrocardiogram in arrhythmias and tachycardias". Am Heart J. 32 (6): 681–8. PMID 20278231.
  11. ↑ VOGEL JH, TABARI K, AVERILL KH, BLOUNT SG (1964). "A SIMPLE TECHNIQUE FOR IDENTIFYING P WAVES IN COMPLEX ARRHYTHMIAS". Am Heart J. 67: 158–61. PMID 14118481.
  12. ↑ Wellens HJ, Bär FW, Lie KI (1978). "The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex". Am J Med. 64 (1): 27–33. PMID 623134.
  13. ↑ Prinzmetal M, Kellogg F(1934): On the significance of the jugular pulse in the clinical diagnosis of ventricular tachycardia. Am Heart J 9:370.
  14. ↑ SCHRIRE V, VOGELPOEL L (1955). "The clinical and electrocardiographic differentiation of supraventricular and ventricular tachycardias with regular rhythm". Am Heart J. 49 (2): 162–87. PMID 13228352.
  15. ↑ WILSON WS, JUDGE RD, SIEGEL JH (1964). "A SIMPLE DIAGNOSTIC SIGN IN VENTRICULAR TACHYCARDIA". N Engl J Med. 270: 446–8. doi:10.1056/NEJM196402272700905. PMID 14163224.
  16. ↑ Strong CF, Levine SA(1923): The irregularity of the ventricular rate in paroxysmal ventricular tachycardia. Heart 10:125.
  17. ↑ Levine SA(1927). The clinical recognition of paroxysmal ventricular tachycardia. Am Heart J 3: 177.
  18. ↑ Harvey WP, Levine SA(1948) The changing intensity of the first sound in auricular flutter, an aid to the diagnosis hy auscultation. Am Heart J 35:924.
  19. ↑ HARVEY WP, CORRADO MA (1957). "Multiple sounds in paroxysmal ventricular tachycardia; an aid in diagnosis by auscultation". N Engl J Med. 257 (7): 325–9. doi:10.1056/NEJM195708152570708. PMID 13464935.
  20. ↑ Strauss MB(1930). Paroxysmal ventricular tachycardia. Am J Med Sci 179:337.
  21. ↑ Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. Ann Intern Med 7:812.
  22. ↑ Riseman JEF, Linenthal H(1941). Paroxysmal ventricular tachycardia. Its favorable prognosis in the absence of acute cardiac damage and its treatment with parenterally administered quinine dihydrochloride. Am Heart J 22:219.
  23. ↑ Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. Arch Intern Med 71:137.
  24. ↑ Cooke WT, White PD(1943). Paroxysmal ventricular tachycardia. Br Heart J 5:33.
  25. ↑ Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. Br Heart J 9:241.
  26. ↑ Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. Ann Intern Med 28:989.
  27. ↑ 27.0 27.1 27.2 ARMBRUST CA, LEVINE SA (1950). "Paroxysmal ventricular tachycardia; a study of 107 cases". Circulation. 1 (1): 28–40. PMID 15401194.
  28. ↑ 28.0 28.1 28.2 HERRMANN GR, PARK HM, HEJTMANCIK MR (1959). "Paroxysmal ventricular tachycardia; a clinical and electrocardiographic study". Am Heart J. 57 (2): 166–76. PMID 13617190.
  29. ↑ 29.0 29.1 MACKENZIE GJ, PASCUAL S (1964). "PAROXYSMAL VENTRICULAR TACHYCARDIA". Br Heart J. 26: 441–51. PMC 1018162. PMID 14196126.
  30. ↑ 30.0 30.1 FROMENT R, GALLAVARDIN L, CAHEN P (1953). "Paroxysmal ventricular tachycardia; a clinical classification". Br Heart J. 15 (2): 172–8. PMC 479483. PMID 13041996.
  31. ↑ Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. Arch Intern Med 71:137.
  32. ↑ Williams. C. Ellis. L.B.: Ventricular tachycardia: an analysis of 36 cases. Arch Intern Med 71:137.
  33. ↑ Parkinson J, Papp C(1947). Repetitive paroxysmal tachycardia. Br Heart J 9:241.
  34. ↑ Lundy CJ, McLellan LL(1934) Paroxysmal ventricular tachycardia: an etiological study with special reference to the type. Ann Intern Med 7:812.
  35. ↑ Schwensen, C: Ventricular tachycardia as a result of tho administration of digitalis. Heart. 9:199, 1922.
  36. ↑ Herrmann CR, Hejtmancik, MR(1948). A clinical and electrocardiographic study of paroxysmal ventricular tachycardia and its management. Ann Intern Med 28:989.

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