Bidirectional Ventricular Tachycardia

Bidirectional ventricular tachycardia is a polymorphic VT with alternating QRS axis (right/left axis beat to beat), classically associated with digoxin toxicity but also seen in catecholaminergic polymorphic VT. Clinical: wide-complex tachycardia with alternating axis. Treatment: stop digoxin; correct electrolytes; digoxin-specific antibody for severe toxicity; lidocaine; treat CPVT with beta-blocker; avoid cardioversion unless unstable.

Common Symptoms

Palpitations/syncope; wide-complex tachycardia with alternating axis; digoxin toxicity/CPVT

Causes and Pathogenesis

Digoxin toxicity (delayed afterdepolarizations) or CPVT causes alternating-axis VT.

Treatment

Stop digoxin; correct electrolytes; digoxin Fab for severe; lidocaine; beta-blocker for CPVT

Preventive Measures

Monitor digoxin levels; avoid toxicity.

Department to Visit

It is recommended to visit the Cardiology/EP-Emergency department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.