Template:ACLS Wide Regular Tachycardia: Difference between revisions
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===[[Wide complex tachycardia| | ===[[Wide-complex tachycardia|Wide ''Regular'' Tachycardia]]<ref>American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 7: Adult Advanced Cardiovascular Life Support. ECCguidelines.heart.org</ref>=== | ||
[[File:Lead II rhythm ventricular tachycardia Vtach VT.jpg|thumb|Wide ''Regular'' Tachycardia (consistent with [[ventricular tachycardia]]).]] | |||
''Pulseless: see [[Adult pulseless arrest]]'' | ''Pulseless: see [[Adult pulseless arrest]]'' | ||
*'''Unstable''': Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure | *'''Unstable''': Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure | ||
**[[Synchronized cardioversion]] 100-200J | **[[Synchronized cardioversion]] 100-200J | ||
*'''Stable''': | *'''Stable''': | ||
* | *Medications | ||
**[[Procainamide]] (first-line drug of choice) | |||
***20-50 mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr | |||
**** | ****Alternative administration: 100 mg q5min at max rate of 25-50 mg/min<ref>Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.</ref> | ||
***Stop if QRS duration increases >50% or [[hypotension]] | |||
***[[Amiodarone]] | ***Avoid if [[prolonged QT]] or [[CHF]] | ||
*** | ***Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively <ref>Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2017 May 1;38(17):1329-1335</ref> | ||
***[[ | **[[Amiodarone]] (agent of choice in setting of [[AMI]] or LV dysfunction) | ||
*** | ***150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)<ref>Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.</ref> | ||
**Synchronized [[ | ***Then 0.5 mg/min drip over next 18 hrs (540 mg total) | ||
***Oral dosage after IV infusion is 400 -800 mg PO daily | |||
**Consider [[adenosine]] | |||
***Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see [[rhythm diagnosis in regular wide complex tachycardia]]) | |||
***6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push | |||
**Synchronized [[cardioversion]] (100J) | |||
Latest revision as of 16:54, 30 July 2025
Wide Regular Tachycardia[1]
Wide Regular Tachycardia (consistent with ventricular tachycardia).
Pulseless: see Adult pulseless arrest
- Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
- Synchronized cardioversion 100-200J
- Stable:
- Medications
- Procainamide (first-line drug of choice)
- 20-50 mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
- Alternative administration: 100 mg q5min at max rate of 25-50 mg/min[2]
- Stop if QRS duration increases >50% or hypotension
- Avoid if prolonged QT or CHF
- Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively [3]
- 20-50 mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
- Amiodarone (agent of choice in setting of AMI or LV dysfunction)
- 150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)[4]
- Then 0.5 mg/min drip over next 18 hrs (540 mg total)
- Oral dosage after IV infusion is 400 -800 mg PO daily
- Consider adenosine
- Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see rhythm diagnosis in regular wide complex tachycardia)
- 6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push
- Synchronized cardioversion (100J)
- Procainamide (first-line drug of choice)
- ↑ American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 7: Adult Advanced Cardiovascular Life Support. ECCguidelines.heart.org
- ↑ Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.
- ↑ Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2017 May 1;38(17):1329-1335
- ↑ Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.