Contents

Search

monomorphic ventricular tachycardia

Ventricular tachycardia in which the QRS complexes maintain a single morphology throughout the tachycardia. Etiology: 1) generally from re-entry in patients with structural heart disease 2) in the absence of heart disease, may arise from triggered activity, often originating in the ouflow tract of the right ventricle * also see ventricular tachycardia Management: (also see ventricular tachycardia) 1) hemodynamic instability - immediate DC synchronized cardioversion 2) stable patient, chemical cardioversion a) preserved heart function 1] procainamide* 2] sotalol or other beta-blocker 3] amiodarone 150 mg IV over 10 minutes - initial bolus followed by continuous infusion [5] 4] lidocaine 0.5-0.75 mg/kg IV push b) poor LV ejection fraction 1] amiodarone 150 mg IV over 10 minutes - initial bolus followed by continuous infusion [5] 2] lidocaine 0.5-0.75 mg/kg IV push 3] then DC synchronized cardioversion c) coronary revascularization alone in patients with coronary artery disease is unsufficient to prevent recurrent ventricular tachycardia [4] * procainamide is the agent of choice for chemical cardioversion except in the settings of: 1) acute MI 2) digoxin toxicity 3) poor LV ejection fraction - in these cases, lidocaine remains the agent of choice [2]

General

ventricular tachycardia (VT)

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 148
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
  4. Al-Khatib SM et al. AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017 Oct 30 PMID: 29084731 http://circ.ahajournals.org/content/early/2017/10/30/CIR.0000000000000549
  5. NEJM Knowledge+