- 3 wide complexes in a row is considered ventricular tachycardia; non-sustained if lasts less than 30 seconds
- Sustained ventricular tachycardia is ventricular tachycardia >30 seconds
- WCT is due to true ventricular tachycardia in 80% of cases
- For patients with underlying cardiac disease, this number increases to > 90%
- Multiple other causes must be considered, including Hyperkalemia, Digoxin toxicity, severe metabolic acidosis, and others
- SVT w/ BBB (fixed or rate related)
- SVT w/ accessory pathway
- A flutter w/ BBB
- Sinus tachycardia with BBB (fixed or rate related)
- If less than or ~120 bpm, consider Accelerated Idioventricular Rhythm
- A-fib/flutter w/ variable AV conduction AND BBB (fixed or rate-related)
- A-fib/flutter w/ variable AV conduction AND accessory pathway (eg WPW)
- A-fib + Hyperkalemia
- Polymorphic v-tach/torsades
- Assume ventricular tachycardia until proven otherwise
- See V Tach vs. SVT
Pulseless: see Adult pulseless arrest
- Regular: Synchronized cardioversion 100-200J
- Irregular: Unsynchronized cardioversion (defibrillation) 200J
- Procainamide 100 mg q5min at max rate of 25-50 mg/min
- Until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure) OR
- Max 17 mg/kg total dose given (12 mg/kg if renal failure) OR
- If QRS widens > 50%
- 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)
- Then 0.5 mg/min drip over next 18 hrs (540 mg total)
- Oral dosage after IV infusion is 400 -800 mg PO daily
- Lidocaine 1-1.5mg/kg IV q5min, repeat PRN until up to 300mg/hr
- ≥3 episodes within 24 hours considered electrical storm and may require alternate treatment (i.e. beta blockade, sedation, ablation)
- True Vtach generally has rate >120bpm. If rate <120bpm or refractory to other therapy, consider other causes
- When in doubt, use cardioversion for treatment of regular WCT. In irregular WCT, consider Afib with WPW in which Procainamide is the treatment of choice.
- In very wide complex (>0.2 msec) and <120 bpm in a patient with significant history, consider giving calcium chloride to treat hyperkalemia
- Consider Acidosis
- Sodium channel blockade (e.g. from benadryl, TCA, or cocaine toxicity) may cause very wide complex (>0.2msec) tachycardia with rate <120bpm
- Admit all patients (even if converted to NSR in ED)
- ACLS: Tachycardia
- ACLS (Main)
- V Tach vs. SVT
- Paroxysmal supraventricular tachycardia
- Nonsustained ventricular tachycardia
- Polymorphic ventricular tachycardia
- Gupta AK, Thakur RK. Wide QRS complex tachycardias. Med Clin North Am. 2001;85(2):245–66– ix–x.
- Akhtar M, Shenasa M, Jazayeri M, Caceres J, Tchou PJ. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med. 1988;109(11):905–912.
- Stewart RB, Bardy GH, Greene HL. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. Ann Intern Med. 1986;104(6):766–771.
- Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.
- Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.