Here are 5 points to remember about ventricular tachycardia (VT):

 

1.When approaching a wide-complex tachycardia, most cases are VT.  Consider supraventricular rhythms in younger patients and those without structural heart/coronary artery disease. Try to get a twelve-lead ECG and compare it to the baseline. Do not delay synchronized electrical cardioversion if the patient is unstable.

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2.Two newer algorithms (in addition to the Brugada algorithm) can help in distinguishing VT from SVT. They involve looking at single leads: 2 and AVR (Verecki).

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3.For patients with refractory VT persisting despite multiple shocks, consider switching the defibrillator pads to Anterior posterior position. Also think about dual sequential defibrillation—using two defibrillators with pads in anterolateral and anteroposterior positions delivering near-simultaneous shocks

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4.Catheter ablation is emerging as initial therapy for VT in ischemic cardiomyopathy with improved outcomes compared to antiarrhythmic drugs. This is an option in addition to standard drugs like Amiodarone and Lidocaine.

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5.Use new technologies. Integrate POCUS to support VT diagnosis (by identifying structural heart disease) and in real time to confirm VT related instability (e.g visualize fine VT/VF).  Wearable devices can provide real-time or historical rhythm strips, helping confirm VT episodes, especially in patients presenting with palpitations or syncope.

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