A 60-year-old female with a history of ventricular tachycardia (VT) presented with shortness of breath and palpitations after discontinuing her medication. The ECG showed right ventricular outflow tract (RVOT) VT identified by its characteristic morphology, and the patient was successfully treated with synchronized DC shock. RVOT tachycardia is typically benign and may respond to acute interventions or long-term therapies; it accounts for 10% of all VT cases.

1. ECG PRESENTATION- RVOT VT
By Dr Kishor

2. • 60 YR OLD FEMALE PRESENTED WITH C/O
• SOB X 3 DAYS
NYHA class II
• Assosciated with PALPITATION
• No H/O CAD in past
• k/c/o SHTN since 10yrs

3. • H/O documented VT 1yr back reverted to sinus rhythm by
injection amoidarone.
• Since then patient on Tab amiodarone and Tab metoprolol
and patient stop drug byself for past 1 month
• 2D ECHO 1 YR BACK
LVID- 4.6/2.9/55%
NORMAL LVSF
GRADE I LVDD
NO MS/MR
NO AS/AR
NO PHTN
NO PE, NO CLOT

5. • CONSCIOUS, ORIENTED
• BP-130/80
• Inj Amiodarone 150 mg iv bolus given…….VT
not reverted
• Synchronized 100 J DC shock given…….VT
reverted

7. • This form of VT is associated with a
characteristic ECG morphology
Wide complex tachycardia
LBBB
inferior axis suggesting origin from the right
ventricle outflow tract .
• A QS pattern in lead avR and monophasic R
waves in leads II, III, avF and V6.

8. • The RVOT VT is more common in females and
is usually seen in third to fifth decade of life
• RVOT tachycardia is associated with two
conditions:
Idiopathic VT
Arrhythmogenic Right Ventricular Dysplasia

9. Idiopathic VT
• Occurs in structurally normal hearts.
• Accounts for 10% of all VT.
• 70% of idiopathic VT will have a RVOT
morphology.
• Underlying mechanism of c-AMP mediated
triggered activity.
• May respond to adenosine.

10. Arrhythmogenic Right Ventricular Dysplasia
• An inherited myocardial disease associated
with paroxysmal ventricular arrhythmias and
sudden cardiac death.
• Characterized pathologically by fibro-fatty
replacement of the right ventricular
myocardium.

11. • ARVD is associated with characteristic ECG
abnormalities:
Epsilon wave (most specific finding, seen in 30% of
patients)
T wave inversions in V1-3 (85% of patients)
Prolonged S-wave upstroke of 55ms in V1-3 (95% of
patients)
Localised QRS widening of 110ms in V1-3
Paroxysmal episodes of ventricular tachycardia with LBBB
morphology

14. TREATMENT
• Usually benign course
• Good prognosis
1. May respond acutely to carotid sinus massage,
Valsalva maneuvers or intravenous adenosine or
verapamil
2. Long-term oral therapy with either BB or CCB
3. Non-responders (33%)- class I or III
antiarrhythmic agents

15. RFA
• When medical therapy is ineffective or not
tolerated
• High success rate (>80%)

20. Ultrasimple Brugada criterion: RW to peak Time

24. • Brugada algorithm is the most commonly used
algorithm. SN 89%, SP 59.2%.
• The lead II R-wave-peak-time .SN 60%, SP
82.7%.
• The aVR algorithm .SN 87.1%, SP 48%.

26. THANK YOU