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:

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.

RVOT may be precipitated in both patient groups by catecholamine excess, stress, and physical activity.

Example ECGs

Example 1

RVOT tachycardia:

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

Example 2

RVOT tachycardia:

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

Video Lessons

Related Topics

Further Reading

Author Credits

References

  • Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition. Saunders Elsevier 2008.
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
  • 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
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