Template:ACLS Wide Regular Tachycardia

Wide Regular Tachycardia

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
    • 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
  • 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
  • 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)