Idiopathic fascicular left ventricular tachycardia: Difference between revisions
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====[[Synchronized Cardioversion]]==== | ====[[Synchronized Cardioversion]]==== | ||
*Adults: 0.5-1.0 J/kg | |||
*Pediatrics: 0.5-1 J/kg | |||
**If unsuccessful, increase to 2 J/kg | |||
*Consider sedation prior to cardioversion only if it will not significantly delay the procedure | |||
===Stable=== | ===Stable=== | ||
Revision as of 01:32, 22 December 2020
Background
- Also known as fascicular tachycardia, idiopathic fascicular left ventricular tachycardia (ILFVT), Belhassen-type VT, verapamil-sensitive VT, or intrafascicular tachycardia
- Re-entrant tachycardia seen typically in young patients without structural heart disease
Clinical Features
- young adult
- male (60-80%)[1]
- palpitations
- dizziness
- syncope is infrequent
Differential Diagnosis
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
Evaluation
Workup
Diagnosis
Management
Unstable
Synchronized Cardioversion
- Adults: 0.5-1.0 J/kg
- Pediatrics: 0.5-1 J/kg
- If unsuccessful, increase to 2 J/kg
- Consider sedation prior to cardioversion only if it will not significantly delay the procedure
Stable
Vagal Maneuvers
- IFLVT does not usually respond to this treatment
Adenosine
- IFLVT does not usually respond to this treatment
Verapamil
- 10 mg over 1 min
- only administer in stable patients with an established diagnosis of IFLVT