Things to note:
CPR. If no cardiac arrest:
DC cardioversion, 200 J, after sedation with:
If cardiac arrest:
- Diazepam, IV, 10-20 mg.
- If 200 J fails, use 360 J.
- Defibrillate (not synchronised).
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.
OR Only in haemodynamically stable patients:
- Amiodarone, oral, 800 mg daily for 7 days.
- Then 600 mg daily for 3 days.
- Titrate to maintenance dose of 200-400 mg daily.
- 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.
- 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.