Ventricular Rhythms

Ventricular arrhythmias (VAs) are often dreaded by healthcare providers and patients alike. Clinical deterioration is frequent with ventricular tachycardia (VT), which underscores the importance of quickly identifying and managing this arrhythmia. Ventricular flutter is another dangerous rhythm, which itself is one veritable step behind ventricular fibrillation—a rhythm associated with certain death unless defibrillation and anti-arrhythmic medications are utilized immediately. Adding to the complexity of VAs is the concept of aberrant conduction, whereby an impulse may proceed in an abnormal fashion through the conducting system, leading to a wide-complex tachycardia that may look like VT but is not. The clinical vignette alone may make differentiating supraventricular tachycardias (SVTs) with aberrant conduction from VT challenging. Thankfully, there are algorithms that can be used to interrogate the ECG and provide a more objective means for separating aberrant conduction from VT. While treating VAs (particularly in hemodynamically unstable patients) may be nerve-wracking, a comprehensive understanding of the diagnostic criteria for these arrhythmias will be certain to quell anxiety and arm the learner with the knowledge necessary to properly diagnose and manage VAs.