Medications for Ventricular Tachycardia

First-Line Medications for Stable VT

• The American Heart Association recommends amiodarone 150 mg IV over 10 minutes followed by 1.0 mg/min infusion for 6 hours (then 0.5 mg/min) as the first-line pharmacological treatment for hemodynamically stable VT, particularly in patients with structural heart disease or heart failure 1, 2
• For patients with hemodynamically stable VT, the American College of Cardiology recommends assessing hemodynamic stability before selecting any medication, and determining if the patient has a pulse and assessing for adverse signs such as chest pain or acute heart failure 3, 1, 2

Special Situations

• The European Society of Cardiology recommends magnesium as the treatment of choice for Torsades de Pointes (polymorphic VT with long QT), with a dose of 8 mmol (2 grams) IV bolus immediately, followed by a maintenance infusion of 2.5 mmol/hour 3, 1, 5, 2
• The American Heart Association recommends IV beta-blockers combined with amiodarone as first-line therapy for VT storm (recurrent/incessant VT), with the same amiodarone dosing as for stable VT 1, 5, 2

Critical Medications to AVOID in VT

• The American College of Cardiology recommends avoiding the use of calcium channel blockers (verapamil, diltiazem), adenosine, and Class IC antiarrhythmics (flecainide, propafenone) in wide-complex tachycardia or VT, as they can precipitate VT/VF or profound hypotension 2, 1

Practical Administration Pearls

• The British Journal of Sports Medicine recommends administering all IV drugs through a peripheral vein followed by a 20 mL saline bolus to aid delivery to central circulation, and correcting electrolytes (potassium, magnesium) before and during antiarrhythmic therapy 3, 1, 2