Right Ventricular Outflow Tract (RVOT) Tachycardia

Introduction

  • Right ventricular outflow tract (RVOT) tachycardia is a form of monomorphic VT originating from the outflow tract of the right ventricle or occasionally from the tricuspid annulus.
  • It is usually seen in patients without underlying structural heart disease, although may also occur in the context of arrhythmogenic right ventricular dysplasia (ARVD).


Diagnostic features

Other general features of VT, such as fusion and capture beats may also be present.


Causes

RVOT tachycardia is associated with two conditions. RVOT may be precipitated in both patient groups by catecholamine excess, stress, and physical activity:


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.

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.


Example ECG

Example 1

ECG RVOT VT LBBB Inferior axis 2

RVOT tachycardia:

  • Broad complex tachycardia.
  • LBBB-like morphology.
  • Inferior axis (+ 90 degrees).

Example 2

ECG RVOT LBBB VT Inferior Axis

RVOT tachycardia:

  • Broad complex tachycardia.
  • LBBB-like morphology.
  • Inferior axis (+ 90 degrees).

Video Lessons

Professor Sanjay Sharma discusses Right Ventricular VT in ARVD.


Related Topics


References

  • Lerman B, Stein KM, Markowitz SM, Mittal S, Slotwiner DJ. Right Ventricular Outflow Tract Tachycardia: An Update. Cardiac Electrophysiology Review. 2002;6, 1-2:68-71 PMID 11984021

LITFL Further Reading


Advanced Reading


ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

Posted by Dr Ed Burns

Dr Ed Burns . Emergency Physician in Pre-hospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education. Ed is the force behind the LITFL ECG library | + Edward Burns | @edjamesburns

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.