Once in a while, it’s normal to feel like your heart is beating too fast. Maybe you’re nervous or maybe you’ve just finished a long run. But sometimes, a fast heartbeat can signal an underlying medical issue called
ventricular tachycardia, also called “VT” or “V-tach.”
V-tach occurs when your pulse rate is more than 100 beats per minute, and you have at least three irregular heartbeats, or arrhythmias, in a row. Besides palpitations, V-tach can cause symptoms like chest pain, lightheadedness, and fainting.
Untreated V-tach can be dangerous: It’s a major cause of sudden cardiac death. So, what do you do if your physician believes you might have V-tach?
Ventricular Tachycardia (V-Tach) Treatment Steps
“The first step in ventricular tachycardia treatment is to figure out why someone has VT in the first place,” says Gregory E. Supple, MD, an electrophysiologist at Penn Medicine. “It’s a spectrum of diseases.”
While rare, V-tach can be idiopathic, meaning there is nothing else wrong with the heart. But most of the time, V-tach is a result of other heart problems, such as:
Dr. Supple also sees many cases of V-tach that have developed as a result of scar tissue on the heart from a heart attack or heart surgery.
“As part of the ‘why’ process, we look at the structure of the heart,” explains Dr. Supple. “We may use an ultrasound to see how your heart squeezes, or stress tests and catheterization to test for previous heart attacks. If there is any weakness, we look for scar tissue.”
In addition to ultrasounds, you will need an electrocardiogram (EKG, ECG)—which measures electrical activity in your heart. If your cardiologist suspects scar tissue, he might perform a type of scan called a cardiac MRI.
“The last part of this step is determining how serious the issue is,” Dr. Supple says. “Some cases are very benign and most likely won’t cause any problems. Some show markers that they could cause sudden death. All of these pieces come together to help us decide how we’re going to treat the V-Tach.”
V-Tach Medication: the Pros and Cons
There are many different types of v-tach treatment available, including a wide variety of medications. However, Dr. Supple warns that while these medications can be very effective, they can also have serious side effects.
“Some rhythm medications need to be monitored closely, and at least one can cause damage to your lungs, thyroid, or liver if used for months or years,” says Dr. Supple. “It’s very important to monitor carefully and to use medication as a sort of ‘bridge,’ or short-term strategy where we can get things under control.”
What is a Cardiac Ablation?
Since long-term medication use can have side effects, many patients opt for a minimally invasive procedure called cardiac ablation.
In this procedure, physicians use catheters to find and trigger V-tach episodes. This helps them locate the “spot” in the ventricle where they’re originating.
The physicians then use radiofrequency energy to heat up the abnormal heart tissue. This destroys the cells that are generating the abnormal electrical energy that’s causing V-tach episodes.
According to Dr. Supple, it’s an effective procedure performed carefully, with sophisticated technology.
“The surgery is often four to eight hours long,” he says. “It involves a lot of work with big IVs through the groin and major blood vessels, X-rays, ultrasounds and electrical mapping systems. All of this helps us determine where the V-tach is coming from, so we can target the correct tissue.”
Despite the fact that it’s complex, ablation is not a procedure to be worried about, especially if you’re at Penn. As Dr. Supple says, “That’s something we’re known for at Penn—being excellent at ablation.”
“We understand that all patients are unique, so all procedures need to be customized to the patient. We take into account each patient’s individual needs. And it works: The success rate is over 90%.”
Implantable Cardioverter Defibrillators: It’s What’s on the Inside
Not sure ablation or medication are the best options for you? Penn also can treat V-tach patients with implantable cardioverter defibrillators. These devices are attached to your heart with wires that will give an electric shock to restore a normal heartbeat if it detects V-tach.
"On TV shows, patients are often revived with paddles. Implantable cardioverter defibrillators do the exact same thing - just much more quickly," says Dr. Supple.
Implantable cardioverter defibrillators stop V-tach, but they do not prevent it. However, they can be given out as a preventative measure. Dr. Supple often treats patients who are getting a defibrillator after having had heart attacks.
“It’s like a life insurance policy,” he says. “They may not have V-tach now, but we know it’s something they could be at risk for down the line, and we want to make sure they’re protected.”
This protection especially comes in handy if you suddenly have a series of V-tachs, which Dr. Supple refers to as a “VT storm.” During a storm, you might receive multiple shocks from the defibrillator.
“That’s when you need to get medical help immediately,” says Dr. Supple. “And that’s when a defibrillator can save your life.”