• Absence of structural heart disease in ventricular tachycardia patient always indicates good prognosis? Not always! (just remember Brugada)
  • Multiple morphologies of ventricular tachycardia are from different sites? Not always- they may be from the same site, but with different exits.
  • Rate of ventricular tachycardia may vary from 70 to 250 bpm.
  • Cutoff time for non-sustained ventricular tachycardia is 30 seconds.
  • AV dissociation is always present in ventricular tachycardia? No, there is VA conduction in 25% cases.
  • Capture beat is always premature while fusion beat is not! (Think!)
  • Very short RP interval of 100 msec favors supraventricular arrhythmia with aberrancy over ventricular tachycardia.
  • If you can find a link between P and QRS suggesting that QRS is dependent on P (eg antegrade Wenckebaching) then that favors supraventricular arrhythmia with aberrancy over ventricular tachycardia.
  • Termination of tachycardia by vagal maneuvers always indicates supraventricular arrhythmia? No, RVOT ventricular tachycardia is also terminated.
  • Check out this linkĀ  http://www.heartpearls.com/2009/06/what-are-the-main-features-of-supraventricular-tachycardia-with-aberrancy-that-helps-to-distinguish-if-from-ventricular-tachycardia.html
  • In ventricular tachycardia, HV interval is always negative? No, it may be short positive, if the focus is near the His bundle.
  • During a wide complex tachycardia, His potentials dissociated from ventricular potentials indicate that it is ventricular tachycardia.
  • For inducing ventricular tachycardia during electrophysiological stimuli, the premature stimulus used is early, not late.
  • In coronary artery disease patients, ventricular tachycardia is more in the morning.
  • Commonest cause of ventricular tachycardia is coronary artery disease. Next commonest is cardiomyopathy, hypertrophic or dilated.
  • Patients with ventricular tachycardia are more likely than patients with ventricular fibrillation to have previous myocardial infarction and low ejection fraction.
  • The best non-invasive marker of prognosis in ventricular tachycardia is low ejection fraction.
  • The best electrophysiological marker of prognosis in ventricular tachycardia is inducibility.
  • The best upcoming ECG indicator of prognosis in ventricular tachycardia is T wave alternans.
  • Primary prevention ICD trials– spot the trials with the following findings-
    • After CABG, ICD did not reduce mortality in patients with abnormal signal averaged ECG.
    • After MI,
      • ICD reduced mortality in patients with low ejection fraction, NSVT and inducible VT,
      • ICD reduced mortality in patients with low ejection fraction and NSVT,
      • ICD reduced mortality in patients with low ejection fraction and frequent VPCs but
      • ICD did not reduce mortality in low ejection fraction alone when implanted immediate post MI.
    • In heart failure,
      • ICD reduced mortality in wide QRS and NYHA 3 to 4,
      • ICD reduced mortality in low ejection fraction with VPCs or NSVT and
      • ICD reduced mortality in low ejection fraction with NYHA 2 to 3.
  • Primary prevention ICD trials- answers-
    • After CABG, ICD did not reduce mortality in patients with abnormal signal averaged ECG (CABG-PATCH)
    • After MI,
      • ICD reduced mortality in patients with low ejection fraction, NSVT and inducible VT (MADIT)
      • ICD reduced mortality in patients with low ejection fraction and NSVT (MUSTT)
      • ICD reduced mortality in patients with low ejection fraction and frequent VPCs (MADIT II)
      • ICD did not reduce mortality in low ejection fraction alone when implanted immediate post MI (DINAMIT)
    • In heart failure,
      • ICD reduced mortality in wide QRS and NYHA 3 to 4 (COMPANION)
      • ICD reduced mortality in low ejection fraction with VPCs or NSVT (DEFINITE)
      • ICD reduced mortality in low ejection fraction with NYHA 2 to 3 (SCD-HeFT).
  • The trials which showed that ICD is better than drugs for secondary prevention of cardiac arrest are CASH, AVID and CIDS.
  • Propranolol was found to reduce total and sudden deaths post MI in the BHAT trial.
  • Amiodarone was found to reduce mortality in low ejection fraction patients in the GESICA trial.