Management of Unstable Ventricular Tachycardia

Initial Management of Unstable VT

• The American Heart Association recommends immediate synchronized cardioversion as the first-line treatment for hemodynamically unstable ventricular tachycardia, as these patients require prompt restoration of sinus rhythm 2, 3
• Signs of hemodynamic instability include hypotension, altered mental status, signs of shock, chest pain, or acute heart failure symptoms 4, 3

Repeated Cardioversion Protocol

• If initial cardioversion is unsuccessful, repeated attempts should be made after adjusting the location of the electrodes, applying pressure over the electrodes, or following administration of an antiarrhythmic medication 1

Antiarrhythmic Medication Support

• The American College of Cardiology recommends considering administering an antiarrhythmic medication, such as amiodarone (150 mg IV over 10 minutes), before subsequent cardioversion attempts for preventing recurrent VT 2
• Procainamide (10 mg/kg) has shown improved reversion rates in hemodynamically stable monomorphic VT 5
• Sotalol (1.5 mg/kg over 5 minutes) has been found to be relatively safe and effective 2

Post-Cardioversion Management

• Beta-blockers may be beneficial for patients with recurrent and refractory ventricular arrhythmias 5

Cautions and Contraindications

• The American College of Cardiology states that electrical cardioversion is contraindicated in patients with digitalis toxicity or hypokalemia 6