Pulseless ventricular tachycardia occurs when an abnormally rapid heart rate originating in the heart’s lower chambers makes a pulse undetectable. Emergency cardiac defibrillation is usually necessary.

Ventricular tachycardia (V-tach) is a heart condition that begins in the heart’s lower chambers (ventricles) and causes the heart to beat abnormally fast.

A diagnosis of pulseless V-tach means no pulse is detectable. It’s a major cause of sudden cardiac arrest, which is when your heart suddenly stops working.

Pulseless V-tach is often a complication related to a structural problem with the heart. In many cases, healthcare professionals can treat it with procedures to “shock” the heart into a healthy rhythm and with medications to help keep the heart beating regularly.

This article examines the differences between V-tach with and without a pulse. It also reviews how doctors diagnose and treat pulseless V-tach and what the outlook is for people with this condition.

What is the difference between V-tach and pulseless V-tach?

Ventricular tachycardia is an arrhythmia (heart rhythm disturbance) that occurs when the electrical signals in the ventricles cause the heart to beat at least three times in a row and at a rate of more than 100 beats per minute (bpm). A typical resting heart rate is between 60 and 100 bpm.

Not all cases of V-tach are pulseless V-tach. If the heart beats so fast that the chambers don’t have time to fill with blood in between each heartbeat, then the heart can pump little or no blood, so there’s no discernible pulse.

If your V-tach still allows blood to fill the heart’s four chambers and get pumped out to the rest of the body, you will maintain a pulse, albeit a rapid or a faint one.

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Pulseless V-tach impairs your heart’s ability to pump blood and maintain a pulse. It causes sudden cardiac arrest and interrupts blood flow to the brain, leading to:

  • sudden collapse with loss of consciousness
  • absent or ineffective breathing
  • unresponsiveness
  • lack of pulse

In some cases, the following symptoms may precede pulseless V-tach:

If someone close to you is unconscious without a pulse, you don’t need to know the cause before starting CPR or using a defibrillator. During CPR, medical professionals apply a heart rhythm monitor that can diagnose VT.

Many public spaces also have access to automated external defibrillators (AEDs). These devices can help detect V-tach and guide you through the process of using the defibrillator to restore someone’s heart rhythm.

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Pulseless V-tach is a medical emergency that requires CPR and defibrillation.

CPR using chest compressions can help save a life. If you see someone collapse and is not responsive, call for help and start chest compressions by pressing hard and fast on the center of the chest.

If someone with V-tach doesn’t immediately respond to defibrillation, 2023 guidelines from the American Heart Association recommend using amiodarone, a medication to prevent or treat several types of arrhythmias, or lidocaine, a common local anesthetic.

Many conditions can cause your heart’s electrical system to trigger an arrhythmia. Usually, a structural problem is the underlying cause. Among the conditions most often associated with pulseless V-tach are:

Conditions such as long QT syndrome and Brugada syndrome can also bring on pulseless V-tach. An electrolyte imbalance may also trigger V-tach and potentially pulseless V-tach.

People with cardiovascular disease or other heart-related conditions are most at risk for pulseless V-tach. This includes people who have had a heart attack or heart failure.

If you have a congenital heart condition, such as long QT syndrome, you may also be at a higher risk for pulseless V-tach.

V-tach is a common cause of sudden cardiac death. Without emergency treatment, pulseless V-tach is fatal.

Rapid treatment is key to a positive outcome. With early initiation of CPR after cardiac arrest, chances of survival double or triple.

While there’s no guaranteed strategy to prevent pulseless V-tach, a heart-healthy lifestyle can reduce your risk of future episodes.

Consider the following tips to improve your heart health.

A doctor may also recommend an implantable cardiac device (ICD) that can monitor your heart rhythm and enable immediate treatment of dangerous arrhythmias like V-tach and ventricular fibrillation.

If you have cardiovascular disease or other heart conditions, be aware that you may be at higher risk for pulseless ventricular tachycardia. Talk with a doctor about your risk and what precautions you should take.

You may want to ensure people in your home and at work know CPR and that a defibrillator is available if necessary. If you experience a rapid pulse with chest discomfort, shortness of breath, or lightheadedness, seek medical attention immediately.