Bidirectional Ventricular Tachycardia (BVT)

Bidirectional Ventricular Tachycardia Overview
  • Bidirectional ventricular tachycardia (BVT) is a rare ventricular dysrhythmia characterised by a beat-to-beat alternation of the frontal QRS axis.
  • In the example above, you can see the QRS axis shifts 180 degrees from left to right with each alternate beat.
  • Another possible pattern is alternating left and right bundle-branch block (see Figure 2 in the paper by Smith et al).
ECG Bidirectional Ventricular Tachycardia 2
Bidirectional ventricular tachycardia

ECG Examples
Example 1
ECG Bidirectional Ventricular Tachycardia BVT 3
  • Multifocal ectopy and bidirectional VT secondary to digoxin poisoning

Example 2
ECG Bidirectional Ventricular Tachycardia BVT 4
  • Bidirectional VT due to digoxin toxicity

Example 3
CPVT Catecholaminergic Polymorphic Ventricular Tachycardia

Exercise stress test in a patient with CPVT.

  • Progressively worsening ventricular arrhythmias are observed during exercise.
  • Typical bidirectional VT develops after 1 minute of exercise with a sinus heart rate of approximately 120 beats per minute.
  • Arrhythmias rapidly recede during recovery.


Advanced Reading



LITFL Further Reading




Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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