Features of ventricular paroxysmal tachycardia

Ventricular tachycardia is classified by time of occurrence as follows:

  • The paroxysmal form manifests itself sharply. During the development of an attack, the frequency of contractions exceeds 130 beats per minute. The patient will need to provide emergency assistance.
  • The manifestation of a nonparksmal form is characteristic of group extrasystoles, that is, extraordinary contractions. Arrhythmia does not occur paroxysmally, therefore, immediate action is not required. It is also not recommended to postpone treatment so that it does not develop into a paroxysmal type of failure.

In its form, ventricular arrhythmia is divided into the following types:

  • The monomorphic type of failure is characterized by 1 focus of an ectopic impulse. It manifests itself mainly due to heart disease.
  • A polymorphic variety is characterized by 2 or more sources of a substitute signal. It manifests itself mainly due to hereditary pathologies or the effects of drug therapy.

In its course, arrhythmia is classified as follows:

  • The stable form has several foci of an ectopic signal and has a negative effect on blood circulation. Her attack lasts over 30 seconds, and her pulse reaches 200 beats per minute.
  • The unstable form does not particularly affect hemodynamics (blood movement). Her attack lasts no more than 30 seconds.
  • The chronic form can occur imperceptibly up to several months, until obvious symptoms of impaired circulation appear. It is characterized by short attacks of ventricular tachycardia.


Ventricular tachycardia is determined on an ECG (electrocardiography). The indicators usually show wide altered QRS complexes with a reduction frequency of up to 150 beats per minute. Atrioventricular dissociation is also observed. It represents a malfunction in the conduction system, in which the atria and ventricles have different sources of impulses, therefore, are reduced individually. The rhythm basically stays right.

By type of QRS complexes, the ventricular form of tachycardia is divided into the following types:

  • monomorphic (the complex does not change);
  • polymorphic (there is a constant deformation of the complexes).

The polymorphic “pirouette” type (bidirectional spindle-shaped) is particularly distinguished by the elongated QT interval. It occurs most often in the presence of congenital malformations, cardiac ischemia, a decrease in magnesium levels, and during use as a treatment for arrhythmias, Amiadorona (Cordarona) and Procainomide.

Difficulties arise only with the difference between ventricular tachycardia and supraventricular (atrial) form. The clinical manifestations characteristic of malfunctions can help. Atrial arrhythmias are characterized by symptoms of autonomic dysfunction (excessive sweating, polyuria and others). The ventricular form does not appear with such signs.

In addition to the ECG, other methods of examination may be required for an accurate diagnosis:

  • Ultrasound (ultrasound) of the heart is used to study the structure of the organ and its contractility.
  • Computer and magnetic resonance imaging is prescribed for a detailed study of tissues and the search for the causes of arrhythmia.
  • Daily ECG monitoring is designed to study the work of the heart during the day to understand when arrhythmias occur and under what circumstances.
  • Coronoangriography is used to see the condition of the vessels.
  • Ventriculography is used to study the ventricles by injecting a contrast medium into a vein.
  • Bicycle ergometry is used to evaluate the work of the heart muscle while receiving physical activity.

For a comprehensive examination, blood donation will also be required to exclude inflammatory processes. It is equally important to conduct its biochemical analysis to identify the causative factor, focusing on cholesterol, glucose, potassium, magnesium and other indicators.

Paroxysmal tachycardia is recognized by the severity of the attack (sudden onset and sudden termination) and data obtained from a study of the heart. The supraventricular and ventricular forms differ in the degree of increased heart rate:

  • with ventricular tachycardia, the heart rate is up to 180 beats / min, samples with excitation of the vagus nerve are negative;
  • with supraventricular tachycardia, the heart rate is about 220-250 beats / min, the attack is easily stopped by excitation of the vagus nerve.
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An ECG for paroxysmal tachycardia shows a change in the polarity and shape of the P wave, as well as a violation of its location in relation to the ventricular complex QRS. These signs allow you to judge what form of the disease in question.

So, an ECG with atrial paroxysmal tachycardia shows the location of the positive / negative P wave in front of the QRS complex. If paroxysm originates from the atrioventricular junction, a negative P wave located behind / merging with the QRS complex is fixed. An ECG during ventricular paroxysmal tachycardia registers the expansion and deformation of the QRS complex, and an unchanged R wave can also be recorded.

Paroxysm of tachycardia is not always possible to fix using an ECG. Then cardiologists resort to daily monitoring of the ECG, which allows you to observe short episodes of seizures that are not subjectively felt by the patient.

In some cases, an endocardial electrocardiogram is recorded by introducing electrodes into the heart.

Alternative medicine

It is impossible to completely eliminate the ventricular form of tachycardia, but it is possible to reduce the number of seizures that occur and improve the patient’s condition. Drugs with antiarrhythmic action and recommendations on lifestyle correction will help to cope with the problem. In severe cases, surgery and electric shock treatment are required to restore normal heart rhythm.

Treatment of ventricular tachycardia should help achieve these goals:

  • Eliminate the main pathological process that provokes malfunctions in the heart rhythm.
  • Timely stop arising paroxysms of ventricular tachycardia and restore the usual rhythm.
  • Prevent seizures.

The essence of drug treatment of ventricular tachycardia is the use of drugs with an antiarrhythmic effect. The following groups of drugs are mainly used:

  • Beta-blockers (Betacard, Lokren, Aritel) reduce the frequency of contractions and blood pressure, reducing the effect of adrenaline on the heart muscle.
  • Calcium antagonists (Altiazem, Amlodipine, Cordipin) prevent it from entering cardiomyocytes (heart cells), which reduces the severity of arrhythmia and stabilizes pressure.

Other antiarrhythmic drugs are prescribed, focusing on the main pathological process. Complement treatment with sedative medications and vitamin complexes. With the development of ventricular fibrillation, the only way to save a person is to do defibrillation (electropulse therapy) to restart the heart. Otherwise, the person will die. The procedure can be carried out by an ambulance team or doctors in a hospital setting.

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Urgent care

During an attack, it is recommended to call an ambulance for emergency care:

  • Paroxysm of ventricular tachycardia, not complicated by circulatory disorders, is quickly stopped by Lidocaine. If the drug did not have the desired effect, then you can enter small doses of Procainamide until the usual heart rhythm is restored.
  • The ventricular form of arrhythmias of the Pirouette type is eliminated by input of Magnesia Sulphate. If the effect is mild, then you can inject another 1 dose of the drug. It is also suitable as a complement to treatment with Lidocaine and Procainamide injections.
  • An attack of ventricular arrhythmia, complicated by malfunctions in the circulation, requires diffibrillation. After restoration of the sinus rhythm, treatment is continued with the introduction of Lidocaine
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After receiving help, a person is hospitalized to continue therapy in a hospital. With constant monitoring, doctors will be able to timely stop attacks and reduce their frequency.

In severe cases, when drug treatment does not help and arrhythmia threatens the patient’s life, it is recommended to perform an operation. Its purpose is to eliminate the ectopic focus of signals or install an artificial pacemaker. You can see the features of such types of surgical intervention below:

  • Radiofrequency ablation is used to eliminate the source of false signals. For the operation, it will be necessary to insert a catheter into the femoral vein and deliver it to the heart muscle. The procedure is carried out only if the exact localization of the ectopic focus of pulses has been clarified.
  • Mounting a pacemaker or defibrillator under the pectoral muscle with the introduction of electrodes through the clavicular vein into the heart departments will help cope with ventricular tachycardia. The device will adjust the rhythm, preventing the development of paroxysms. The batteries in it will last for 10 years, and then they will have to be replaced in a special center.

As measures to prevent the development of ventricular tachycardia and reduce the frequency of its attacks, it is recommended to observe the following rules:

  • timely treat diseases that provoke the appearance of arrhythmia;
  • give up alcohol and smoking;
  • avoid stressful situations;
  • control weight;
  • reduce physical and mental stress;
  • properly compose a diet;
  • take vitamin complexes useful for the heart;
  • follow all doctor’s recommendations and be examined 1 time per year;
  • sleep at least 7-8 hours a day;
  • monitor that the level of sugar and cholesterol remains normal;
  • to exercise at a moderate pace.

At home, it is allowed to combine the main treatment regimen with alternative medicine, for example, with folk remedies. You can prepare an effective medicine to saturate the body with useful substances and improve heart function according to the following recipes:

  • Take 2 tbsp. l motherwort, goldenrod, lemon balm, buckwheat flowers and mix together. 2 tbsp. l the resulting collection, pour 500 boiling water and wait until it cools. Before use, the infusion must be filtered. Drink the medicine for 2 weeks, 1 cup throughout the day. After the course of therapy, there is a seven-day break, and then it can be repeated again.
  • Take 1 tbsp. l motherwort, goldenrod, seeds of flax, viburnum, valerian and mix in one container. Prepare an infusion similar to the previous recipe. Drink 1 glass for a month.
  • 1 tsp Adonis mix with stalnik roots, birch and sunflower leaves, taken in 1 tbsp. l Next, take 30 g of the collection and pour 500 ml of boiling water. Then put the container in a water bath for about 20 minutes. After cooling, strain the broth. Take 0,5 cups 2-3 times a day. The course lasts 30 days.
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The treatment regimen for paroxysmal tachycardia depends on:

  • forms of arrhythmia (ventricular, atrial, atrioventricular);
  • the causes of the disease;
  • duration and frequency of paroxysms;
  • presence / absence of complications.

Attacks of paroxysmal tachycardia require emergency hospitalization (with the exception of idiopathic options with a benign course, which are easily stopped by administering an antiarrhythmic drug).

Emergency care for paroxysmal tachycardia includes intravenous administration of antiarrhythmic drugs (Propranolol, Aymalin, Ritmodan, Quinidine, Etmozin, Cordaron, Isoptin, etc.). If the attack is long and does not stop with drugs, electro-pulse therapy is performed. Then the patient undergoes outpatient cardiological treatment, during which effective antiarrhythmic drugs are selected.

Doctors often use vagal maneuvers – techniques that have a pronounced mechanical effect on the vagus nerve, to stop tachycardia paroxysm. These include:

  • straining;
  • Ashner’s test (moderate and uniform pressure on the inner upper corner of the eyeball);
  • Valsalva test (vigorous exhalation with a closed oral cavity and nasal cleft);
  • irritation of the root of the tongue to cause a vomiting reflex;
  • Chermak-Goering test (uniform pressure on the carot >

If attacks of paroxysmal tachycardia occur several times a month, the patient is prescribed long-term anti-relapse therapy:

  • quinidine preparations (Disopyramide, Kinilentin, Amiodarone, Verapomil, etc.);
  • cardiac glycosides (Celanide, Digoxin).

The selection of an effective dosage is carried out taking into account the well-being of the patient and the results of the ECG.

Surgical treatment of paroxysmal tachycardia is used only if the disease is severe and can not be stopped by drugs. Among the most common surgical methods:

  • mechanical, laser, electrical, cryogenic, chemical destruction of additional pathways for conducting an impulse or ectopic foci of automatism;
  • RFA;
  • implantation of a pacemaker;
  • implantation of an electric defibrillator.

If the patient wants to treat paroxysmal tachycardia with alternative methods, he should first consult with a cardiologist, since refusing to take the prescribed antiarrhythmic drugs can lead to serious complications.


Without timely assistance, the prognosis is usually unfavorable. The patient expects death from ventricular fibrillation or cardiac arrest. Otherwise, severe complications develop that significantly reduce the quality of life, but ultimately also lead to death.

If all the recommendations of the doctor are observed, the situation changes dramatically. The patient can live for many years, changing his lifestyle and taking medication. Installing an artificial pacemaker or cauterizing an ectopic signal source are extremely effective procedures that can significantly improve a person’s condition.

Ventricular tachycardia is a dangerous type of arrhythmia that often leads to the development of fatal complications. For him, certain symptoms and indications on the ECG are characteristic, which greatly simplifies the diagnosis. Treatment consists of a combination of traditional methods with folk remedies and lifestyle correction.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.