Key result
High-dose beta blockers effectively manage idiopathic bidirectional ventricular tachycardia.
Why the study?
Bidirectional ventricular tachycardia is a rare arrhythmia with diagnostic and management challenges, especially in structurally normal hearts without definitive etiology.
Case Report (n=1)
This case highlights the diagnostic and therapeutic challenges of bidirectional ventricular tachycardia in a structurally normal heart, where individualized medical management with high-dose beta blockers may be chosen over an ICD to avoid proarrhythmic shocks.
Bidirectional ventricular tachycardia (BDVT) is a rare arrhythmia marked by beat-to-beat QRS axis alteration. We report a 36-year-old female with recurrent palpitations who presented with BDVT degenerating into polymorphic ventricular tachycardia and ventricular fibrillation. An extensive evaluation, including cardiac magnetic resonance imaging (MRI), stress and adrenaline provocation testing, and a comprehensive genetic arrhythmia panel, revealed no definitive etiology. Given the concern for proarrhythmic implantable cardioverter-defibrillator (ICD) shocks in a potential channelopathy and after shared decision-making, the patient was managed with high-dose beta blocker therapy. This case underscores the diagnostic and management challenges of BDVT in a structurally normal heart, particularly when balancing guideline recommendations against individualized patient factors.
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Limaye et al. (2026) conducted a case report in Bidirectional ventricular tachycardia (BDVT) (n=1). High-dose beta blocker therapy was evaluated. High-dose beta blocker therapy was utilized to manage bidirectional ventricular tachycardia in a 36-year-old female after extensive evaluation revealed no definitive etiology for the arrhythmia.
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