Treatment of Stable Wide-Complex Tachycardia
Regular
• If ventricular tachycardia or uncertain rhythm:
- Give amiodarone 150 milligrams IV over 10 min
- Repeat if necessary to max 2.2 grams/24 h
- Prepare for synchronized cardioversion
• If known SVT with aberrancy, then give adenosine
Irregular
• If preexcitation with AF (AF + WPW)
- Avoid AV nodal agents (e.g., diltiazem or B-blockers)
- Consider antiarrhythmics (amiodarone or procainamide)
- Consider expert consultation
• If torsades de pointes
- Give magnesium sulfate 2 grams V
- Consider expert consultation
• If polymorphic ventricular tachycardia
- Prepare for synchronized cardioversion
- Consider expert consultation
• If AF with aberrancy
- Follow narrow-complex irregular protocol
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