- 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).
- Heart rate > 100 bpm.
- QRS duration > 120 ms.
- LBBB Morphology.
- Rightward / inferior axis (around +90 degree).
- Atrioventricular dissociation.
Other general features of VT, such as fusion and capture beats may also be present.
RVOT tachycardia is associated with two conditions:
- 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.
Professor Sanjay Sharma discusses Right Ventricular VT in ARVD.
- 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
- Hampton, JR. The ECG In Practice, 6e
- Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric, 6e
- Wagner, GS. Marriott’s Practical Electrocardiography 12e
- Chan, TC. ECG in Emergency Medicine and Acute Care
- Mattu, A. ECG’s for the Emergency Physician
LITFL Further Reading
- ECG BASICS — Waves, Intervals, Segments and Clinical Interpretation
- ECG A to Z by diagnosis –alphabetical diagnostic approach to the ECG
- ECG CLINICAL CASES — ECG’s placed in clinical context with a challenging Q&A approach
- 100 ECG Quiz — Self-assessment tool for examination practice
- ECG Reference SITES and BOOKS — the best of the rest
- LITFL ECG IMAGE Database — Searchable database of LITFL ECG’s
- ECG and Cardiology Eponymous Syndromes — Cheats guide to eponymous emancipation
- ECG Exam Template — a framework for answering ECG exam questions.