Ventricular Tachycardia

UNSTABLE PATIENT

Evidence of worsening heart failure

• Initiate immediate synchronized cardioversion with 100 J, quickly progressing to 200 J, 300 J, and 360 J if no response.

• If VT is polymorphic, begin cardioversion at 200 J

• If unable to terminate the VT, administer lidocaine and repeat the cardioversion.
• Antitachycardia overdrive pacing if torsades
• After successful return of sinus rhythm, begin amiodarone

Stable patient, monomorphic VT

Normal cardiac function at baseline:

• Procainamide or sotalol; may also consider amiodarone or lidocaine
• Avoid sotalol if evidence of prolonged QT or known long QT syndrome.

Impaired cardiac function at baseline:

• Amiodarone bolus, then infusion or lidocaine, then synchronized cardioversion

Stable patient, polymorphic VT:

Normal QT interval at baseline:

• Correct electrolyte abnormalities.
• Treat ischemia if present.
• Then begin 1 of the following: b2-blockers, lidocaine, amiodarone, procainamide, or sotalol

Prolonged QT Torsades de pointes:

• Correct electrolytes.
• Magnesium sulfate or overdrive pacing or 1 of the following:
  • • Phenytoin
    • Lidocaine
    • Isoproterenol is used to overdrive the tachycardia if the patient has no history of coronary artery disease or long QT syndrome. Temporizing measure until external pacing available

Impaired cardiac function at baseline

• Amiodarone bolus or lidocaine bolus then synchronized cardioversion