Bidirectional Ventricular Tachycardia: Challenges and Solutions

Abstract

Ahmed Almarzuqi,1 Shane Kimber,1 Kenneth Quadros,1 Janek Senaratne1,2 1Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; 2Department of Critical Care Medicine, University of Alberta, Edmonton, CanadaCorrespondence: Janek Senaratne, Tel [phone], Fax [phone], Email [email protected]: Bidirectional ventricular tachycardia (BiVT) is a rare form of ventricular tachycardia that manifests on surface electrocardiogram by dual QRS morphologies alternating on a beat-to-beat basis. It was first reported in the 1920s as a complication of digoxin, and since then, it has been reported in other conditions including fulminant myocarditis, sarcoidosis, catecholaminergic polymorphic ventricular tachycardia, and Andersen-Tawil syndrome. The mechanism for BiVT is not as well known as other forms of ventricular tachycardia but appears to include typical mechanisms including triggered activity from afterdepolarizations, abnormal automaticity, or reentry. This review will go beyond the definition, surface electrocardiogram, mechanisms, causes, and treatment of BiVT as per our current understanding.Keywords: bidirectional ventricular tachycardia, dual reentry, ventricular arrhythmia, digoxin toxicity, catecholaminergic polymorphic ventricular tachycardia

Keywords

• bidirectional ventricular tachycardia
• dual reentry
• ventricular arrhythmia
• digoxin toxicity
• catecholaminergic polymorphic ventricular tachycardia