treatment

How to Treat Regular Wide Qrs Tachycardias?


Things to note:
CPR.
If no cardiac arrest:
DC cardioversion, 200 J, after sedation with:
  • Diazepam, IV, 10-20 mg.
    • If 200 J fails, use 360 J.
If cardiac arrest:
  • Defibrillate (not synchronised).

Medical Treatment:
DC cardioversion is first line therapy for regular wide QRS tachycardias. Drugs are needed if ventricular tachycardia (VT) recurs after cardioversion, or spontaneous termination.
  • Amiodarone, IV, 5 mg/kg infused over 30 minutes.
Follow with:
  • Amiodarone, oral, 800 mg daily for 7 days.
    • Then 600 mg daily for 3 days.
    • Titrate to maintenance dose of 200-400 mg daily.
    Precautions:
    • If on warfarin, halve the dose of warfarin and monitor INR closely, until INR is stable.
    • Avoid concomitant digoxin.
    • Monitor thyroid function every 6 months as thyroid abnormalities may develop.
    • Ophthalmological examination every 6 months.
OR
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.


treatment