the cellular level, VT is caused by electrical reentry or abnormal automaticity. Myocardial scarring from any process increases the likelihood of electrical reentrant circuits. These circuits generally include a zone where normal electrical propagation is slowed by scar. Ventricular scar formation from a prior myocardial infarction (MI) is the most common cause of sustained monomorphic VT.
VT in a structurally normal heart typically results from mechanisms such as triggered activity and enhanced automaticity. Torsades de pointes, seen in the long QT syndromes, is likely a combination of triggered activity and ventricular reentry.[6]
During VT, cardiac output is reduced as a consequence of decreased ventricular filling from the rapid heart rate and lack of properly timed or coordinated atrial contraction. Ischemia and mitral insufficiency[7] may also contribute to decreased ventricular stroke output and hemodynamic intolerance.
Hemodynamic collapse is more likely when underlying left ventricular dysfunction is present or when heart rates are very rapid. Diminished cardiac output may result in diminished myocardial perfusion, worsening inotropic response, and degeneration to ventricular fibrillation (VF), resulting in sudden death