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Sustained monomorphic ventricular tachycardia: Diagnosis and evaluation

Philip J Podrid, MD, FACC
Section Editor
Leonard I Ganz, MD, FHRS, FACC
Deputy Editor
Brian C Downey, MD, FACC


Sustained monomorphic ventricular tachycardia (SMVT) is a potentially life-threatening arrhythmia which can be differentiated from supraventricular tachycardia, nonsustained ventricular tachycardia, and polymorphic ventricular tachycardia by the following characteristics:

Wide QRS complex tachycardia (WCT) with QRS complex duration >0.12 seconds and a rate of greater than 100 beats per minute

Atrioventricular (AV) dissociation

Uniform and stable QRS morphology, although there may be subtle changes in QRS complex morphology and in the ST-T waves

Duration of at least 30 seconds or development of hemodynamic compromise


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Literature review current through: Nov 2016. | This topic last updated: Fri Aug 29 00:00:00 GMT+00:00 2014.
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  1. Centers for Disease Control and Prevention (CDC). State-specific mortality from sudden cardiac death--United States, 1999. MMWR Morb Mortal Wkly Rep 2002; 51:123.
  2. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med 1993; 119:1187.
  3. Myerburg RJ. Sudden cardiac death: exploring the limits of our knowledge. J Cardiovasc Electrophysiol 2001; 12:369.
  4. Hamer AW, Zaher CA, Rubin SA, et al. Hemodynamic benefits of synchronized 1:1 atrial pacing during sustained ventricular tachycardia with severely depressed ventricular function in coronary heart disease. Am J Cardiol 1985; 55:990.
  5. Saksena S, Ciccone JM, Craelius W, et al. Studies on left ventricular function during sustained ventricular tachycardia. J Am Coll Cardiol 1984; 4:501.
  6. Garratt CJ, Griffith MJ, Young G, et al. Value of physical signs in the diagnosis of ventricular tachycardia. Circulation 1994; 90:3103.
  7. Gupta AK, Thakur RK. Wide QRS complex tachycardias. Med Clin North Am 2001; 85:245.
  8. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001; 345:351.
  9. Akhtar M, Shenasa M, Jazayeri M, et al. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med 1988; 109:905.
  10. Hayes JJ, Stewart RB, Green HL, Bardy GH. Narrow QRS ventricular tachycardia. Ann Intern Med 1991; 114:460.
  11. Militianu A, Salacata A, Meissner MD, et al. Ventriculoatrial conduction capability and prevalence of 1:1 retrograde conduction during inducible sustained monomorphic ventricular tachycardia in 305 implantable cardioverter defibrillator recipients. Pacing Clin Electrophysiol 1997; 20:2378.
  12. Miller JM, Das MK. Differential diagnosis of wide complex tachycardia. In: Cardiac electrophysiology: from cell to bedside, 4th, Zipes DP, Jalife J (Eds), Saunders, 2004. p.751.
  13. Thachil A, Christopher J, Sastry BK, et al. Monomorphic ventricular tachycardia and mediastinal adenopathy due to granulomatous infiltration in patients with preserved ventricular function. J Am Coll Cardiol 2011; 58:48.
  14. European Heart Rhythm Association, Heart Rhythm Society, Zipes DP, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247.
  15. Kiès P, Bootsma M, Bax J, et al. Arrhythmogenic right ventricular dysplasia/cardiomyopathy: screening, diagnosis, and treatment. Heart Rhythm 2006; 3:225.
  16. Marcus F, Towbin JA, Zareba W, et al. Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C): a multidisciplinary study: design and protocol. Circulation 2003; 107:2975.
  17. Denniss AR, Richards DA, Cody DV, et al. Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiograms of survivors of acute myocardial infarction. Circulation 1986; 74:731.
  18. Vaitkus PT, Kindwall KE, Marchlinski FE, et al. Differences in electrophysiological substrate in patients with coronary artery disease and cardiac arrest or ventricular tachycardia. Insights from endocardial mapping and signal-averaged electrocardiography. Circulation 1991; 84:672.
  19. Martinez-Rubio A, Shenasa M, Borggrefe M, et al. Electrophysiologic variables characterizing the induction of ventricular tachycardia versus ventricular fibrillation after myocardial infarction: relation between ventricular late potentials and coupling intervals for the induction of sustained ventricular tachyarrhythmias. J Am Coll Cardiol 1993; 21:1624.
  20. Ommen SR, Hammill SC, Bailey KR. Failure of signal-averaged electrocardiography with use of time-domain variables to predict inducible ventricular tachycardia in patients with conduction defects. Mayo Clin Proc 1995; 70:132.
  21. Steinberg JS, Prystowsky E, Freedman RA, et al. Use of the signal-averaged electrocardiogram for predicting inducible ventricular tachycardia in patients with unexplained syncope: relation to clinical variables in a multivariate analysis. J Am Coll Cardiol 1994; 23:99.
  22. Signal-averaged electrocardiography. J Am Coll Cardiol 1996; 27:238.
  23. Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol 2009; 53:2201.
  24. Rodriguez LM, Waleffe A, Brugada P, et al. Exercise-induced sustained symptomatic ventricular tachycardia: incidence, clinical, angiographic and electrophysiologic characteristics. Eur Heart J 1990; 11:225.
  25. O'Hara GE, Brugada P, Rodriguez LM, et al. Incidence, pathophysiology and prognosis of exercise-induced sustained ventricular tachycardia associated with healed myocardial infarction. Am J Cardiol 1992; 70:875.
  26. Elhendy A, Sozzi FB, van Domburg RT, et al. Relation among exercise-induced ventricular arrhythmias, myocardial ischemia, and viability late after acute myocardial infarction. Am J Cardiol 2000; 86:723.
  27. Graboys TB, Lown B, Podrid PJ, DeSilva R. Long-term survival of patients with malignant ventricular arrhythmia treated with antiarrhythmic drugs. Am J Cardiol 1982; 50:437.
  28. Woelfel A, Foster JR, Simpson RJ Jr, Gettes LS. Reproducibility and treatment of exercise-induced ventricular tachycardia. Am J Cardiol 1984; 53:751.
  29. Sung RJ, Shen EN, Morady F, et al. Electrophysiologic mechanism of exercise-induced sustained ventricular tachycardia. Am J Cardiol 1983; 51:525.
  30. Bayés de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989; 117:151.
  31. Gradman AH, Batsford WP, Rieur EC, et al. Ambulatory electrocardiographic correlates of ventricular inducibility during programmed electrical stimulation. J Am Coll Cardiol 1985; 5:1087.
  32. Linzer M, Pritchett EL, Pontinen M, et al. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope. Am J Cardiol 1990; 66:214.
  33. Krahn AD, Klein GJ, Yee R, et al. Use of an extended monitoring strategy in patients with problematic syncope. Reveal Investigators. Circulation 1999; 99:406.
  34. Kadish AH, Buxton AE, Kennedy HL, et al. ACC/AHA clinical competence statement on electrocardiography and ambulatory electrocardiography. A report of the ACC/AHA/ACP-ASIM Task Force on Clinical Competence (ACC/AHA Committee to Develop a Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography). J Am Coll Cardiol 2001; 38:2091.
  35. Volgman AS, Zheutlin TA, Mattioni TA, et al. Reproducibility of programmed electrical stimulation responses in patients with ventricular tachycardia or fibrillation associated with coronary artery disease. Am J Cardiol 1992; 70:758.
  36. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335:1933.
  37. Buxton AE, Lee KL, Fisher JD, et al. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999; 341:1882.
  38. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346:877.
  39. Daubert JP, Zareba W, Hall WJ, et al. Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients. J Am Coll Cardiol 2006; 47:98.
  40. Steinbeck G, Andresen D, Bach P, et al. A comparison of electrophysiologically guided antiarrhythmic drug therapy with beta-blocker therapy in patients with symptomatic, sustained ventricular tachyarrhythmias. N Engl J Med 1992; 327:987.
  41. The ESVEM trial. Electrophysiologic Study Versus Electrocardiographic Monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. The ESVEM Investigators. Circulation 1989; 79:1354.
  42. Determinants of predicted efficacy of antiarrhythmic drugs in the electrophysiologic study versus electrocardiographic monitoring trial. The ESVEM Investigators. Circulation 1993; 87:323.
  43. Waller TJ, Kay HR, Spielman SR, et al. Reduction in sudden death and total mortality by antiarrhythmic therapy evaluated by electrophysiologic drug testing: criteria of efficacy in patients with sustained ventricular tachyarrhythmia. J Am Coll Cardiol 1987; 10:83.
  44. Kim SG, Seiden SW, Felder SD, et al. Is programmed stimulation of value in predicting the long-term success of antiarrhythmic therapy for ventricular tachycardias? N Engl J Med 1986; 315:356.
  45. Bhandari AK, Hong R, Kulick D, et al. Day to day reproducibility of electrically inducible ventricular arrhythmias in survivors of acute myocardial infarction. J Am Coll Cardiol 1990; 15:1075.