Clinical correlate and acute therapeutic approaches to bidirectional ventricular tachycardia

Abstract Background Bidirectional ventricular tachycardia (BiVT) is an uncommon tachycardia which underlying etiological cause is attributed to multiple pathologies. Purpose to describe the clinical correlates and therapeutic approaches to BiVT. Methods we conducted an ambispective and multicentric registry on 13 hospitals, consisting on relevant clinical characteristics, diagnosis and therapeutics. Results A total of 19 patients were evaluated (63% female). The age distribution was bimodal, with peaks at 21.5 (13;36) and 43 (32;70) years-old, corresponding to varying etiologies. In the younger group, Andersen-Tawil syndrome accounted for 36.84% of cases, and catecholaminergic polymorphic ventricular tachycardia (CPVT) represented 10.53%. Etiologies in the older group were more diverse (see Table). Potassium levels during acute episodes were within the normal range (3.8±4.4 mmol/L). Most episodes occurred without the use of antiarrhythmic medications (63.16%); β-blockers were used in 26.32% of patients, and digoxin in 15.79%. Palpitations were the most frequently reported symptom (52.63%), with cardiac arrest as the primary clinical presentation in three patients (15.79%). Most cases of bidirectional ventricular tachycardia (BiVT) resolved spontaneously, though four cases (none of which were CPVT) required electrical cardioversion, successfully restoring stable sinus rhythm. Recurrence was absent in 87.5% of patients within a short follow-up period, with 48% receiving antiarrhythmic treatment, primarily amiodarone (21.05%), or β-blockers. However, 36.84% of patients experienced additional ventricular arrhythmias (VT or VF) in the acute phase, with 45.54% of these cases requiring cardioversion or defibrillation. All patients presenting with cardiac arrest as the primary symptom were within this group. Supraventricular arrhythmias were observed in 31.58% of patients in the acute setting, with atrial fibrillation being the most common (21.05%). Additional clinical details are available in Table. Conclusions Our study represents the largest population of BiVT described to date. Individuals with cardiac arrest presented with concomitant ventricular arrhythmia.