VA Resident Report: What are the causes of QRS prolongation in an otherwise structurally normal heart?

Ventricular arrhythmia (VA) in structurally normal hearts can be broadly considered under non–life-threatening monomorphic and life-threatening polymorphic rhythms. Monomorphic VA is classified on the basis of site of origin in the heart, and the most common areas are the ventricular outflow tracts and left ventricular fascicles. The morphology of the QRS complexes on electrocardiogram is an excellent tool to identify the site of origin of the rhythm.

Eric N Prystowsky Benzy J Padanilam Sandeep Joshi Richard I Fogel Ventricular arrhythmias in the absence of structural heart disease.
Journal of the American College of Cardiology , 2012, Vol.59(20), p.1733-1744

Polymorphic ventricular tachycardia (VT) is rare and generally occurs in patients with genetic ion channel disorders including long QT syndrome, Brugada syndrome, catecholaminergic polymorphic VT, and short QT syndrome. Unlike monomorphic VT, these arrhythmic syndromes are associated with sudden death. While the cardiac gross morphology is normal, suggesting a structurally normal heart, abnormalities exist at the molecular level and predispose them to arrhythmias.

Table 1 Classification of Ventricular Arrhythmias in the Absence of Structural Heart Disease. : Page 1734

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