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Stable Wide Complex Tachycardia

Date Last Search Run: Apr 18, 2021
Table last updated: May 02, 2021
Data last added: Aug 20, 2018

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)  
3 (weak evidence exists)    


Interventions

Adenosine
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Termination of tachycardia Patient ED-MD Marill K., et al. Adenosine for Wide-Complex Tachycardia: Efficacy and Safety. Crit Care Med 2009; 37(9):2512-8. Medline
III Supportive (Green) Adenosine induced arrhythmia Process ED-MD Camaiti A., Pieralli F., Olivotto I., et al. Prospective evaluation of adenosine-induced proarrhythmia in the emergency room. Eur J Emerg Med 2001; 8(2):99-105. Medline
III Supportive (Green) Termination of monomorphic VT Patient ED-MD Hasdemir C., Musayev O., Alkan MB., Can LH., Kurtursay H. Termination of idiopathic sustained monomorphic ventricular tachycardia by intravenous adenosine in a pregnant woman. Europace 2009; 11(11):1560-1. Medline
III Neutral (Yellow) Termination of arrhythmia Patient ED-MD Kassotis J., Slesinger T., Festic E., Voigt L., Reddy CV. Adenosine-sensitive wide-complex tachycardia: An uncommon variant of idiopathic fascicular ventricular tachycardia—a case report. Angiol 2003; 54(3):369-72. Medline

Antiarrhythmic - Class I (Na+ channel blockers)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Termination of stable monomorphic VT Patient ED-MD Desouza IS., Martindale JL., Sinert R. Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: A systematic review. Emerg Med J 2015; 32(2):161-7. Medline
II Supportive (Green) Maintenance of a non-ventricular rhythm Patient PH-Paramedic Millin MG., Kim S., Schmidt TA., Daya MR., Fujisaki B. Intermittent bolus dosing of lidocaine in emergency medical services-an alternative to bolus followed by a drip. Prehosp Emerg Care 2006; 10(3):403-8. Medline
III Opposes (Red) Conduction disturbance and asystole Patient ED-MD McLean SA., Paul ID., Spector PS. Lidocaine-induced conduction disturbance in patients with systemic hyperkalemia. Ann Emerg Med 2000; 36(6):615-8. Medline

Antiarrhythmic - Class III (K+ channel blockers)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Arrhythmia event rate Patient ICU Scheinman MM., Levine JH., Cannom DS., Frieling T., et al. Dose-Ranging Study of Intravenous Amiodarone in Patients with Life-Threatening Ventricular Tachyarrhythmias. Circ 1995; 92(11):3261-72. Medline
II Supportive (Green) Termination of stable monomorphic VT Patient ED-MD Desouza IS., Martindale JL., Sinert R. Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: A systematic review. Emerg Med J 2015; 32(2):161-7. Medline
II Neutral (Yellow) Rhythm conversion Process ED-MD Yusu S., Ikeda T., Mera H., Miyakoshi M., Miwa Y., Abe A., et al. Effects of intravenous nifekalant as a lifesaving drug for severe ventricular tachyarrhythmias complicating acute coronary syndrome. Circ J 2009; 73(11):2021-2028. Medline
III Neutral (Yellow) Incidence of VT termination prior to transfer of care in the ED Patient Foerster C., Andrew E., Smith K., Bernard S. Amiodarone for sustained stable ventricular tachycardia in the prehospital setting. Emerg Med Australas. 2018: ahead of print Medline
III Neutral (Yellow) Termination of VT Patient ED-MD Marill KA., deSouza IA., Nishijima DK., Stair TO., Setnik GS., Ruskin JN. Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Ann Emer Med 2006; 47(3):217-23. Medline

Electrical Cardioversion
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Termination of VT Patient ED-MD Domanovits H., Paulis M., Nikfardjam M., et al. Sustained ventricular tachycardia in the emergency department. Resuscitation 1999; 42(1):19-25. Medline

Magnesium/Polymorphic VT
Level Direction Primary Outcome Patient/Process Setting Reference


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