Ventricular tachycardia: management

Whilst a broad complex tachycardia may result from a supraventricular rhythm with aberrant conduction, the European Resuscitation Council advise that in a peri-arrest situation it is assumed to be ventricular in origin

If the patient has adverse signs (systolic BP < 90 mmHg, chest pain, heart failure, syncope) then immediate cardioversion is indicated. In the absence of such signs antiarrhythmics may be used. If these fail, then electrical cardioversion may be needed with synchronised DC shocks.

Drug therapy

• amiodarone: ideally administered through a central line
• lidocaine: use with caution in severe left ventricular impairment
• procainamide

Verapamil should NOT be used in VT.

If drug therapy fails

• electrophysiological study (EPS)
• implant able cardioverter-defibrillator (ICD) - this is particularly indicated in patients with significantly impaired LV function