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How to Treat Nonsustained Irregular Wide Qrs Tachycardias?

Medical Treatment:
  • Amiodarone, IV, 5 mg/kg infused over 30 minutes. Specialist initiated.
Follow with:
  • Amiodarone, oral, 800 mg daily for 7 days.
    • Then 600 mg daily for 3 days.
    • Follow with a maintenance dose of 200-400 mg daily, depending upon clinical judgement.
    • If on warfarin, halve the dose of warfarin and monitor INR closely, until INR is stable.
    • Avoid concomitant digoxin.
    • Monitor thyroid function every 6months as thyroid abnormalities may develop.
    • Ophthalmological examination every 6 months.
Only in haemodynamically stable patients:
  • Lidocaine (lignocaine), IV, 50-100 mg (1-2 mg/kg) initially and at 5 minute intervals if required to a total of 200-300 mg.
Thereafter, for recurrent ventricular tachycardia only:
  • Lidocaine, IV infusion, 1-3 mg/minute for 24-30 hours.
  • Lidocaine will only terminate with or without 30% of sustained ventricular tachycardias, and may cause hypotension, heart block or convulsions.
  • For emergency treatment of ventricular tachycardia, DC cardioversion is first-line therapy, even if stable.
  • In the absence of acute ischaemia or infarction, consider torsades de pointes, due to QT prolonging drugs.